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HomeMy WebLinkAbout0018 JULIE LANE I r i =—� TOWN OF BARNSTABLE -+ CERTIFICATE OF OCCUPANCY PARCEL ID 021 101 GEOBASE ID 1011 ADDRESS 18 JULIE LANE PHONE COTUIT ZIP — LOT 5 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CT PERMIT TYPE BCOO1 TITLEIPTiC7N CERTIFICATE OFDOCCUPANC�BLD PER 29247) CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: THE BOND $.00 CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE ; BARN3TABLE. MASS. 1639. Eb MA'S BUILD SIGN r I BY d DATE ISSUED 05/11/1999 EXPIRATION DATE I TOWN OF BARNSTABLE _' ..�• " �-!�' BUILDING PERMIT PARCEL ID 021 101 GEOBASE ID 101.1 I ADDRESS 18 JULIE LANE PHONE I COTUIT - LIP LOT' S BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT PERMIT -. . 29247 DESCRIPTION NE ` 3BDRM SING FAM HOME SEW.PT:.-fig''- _ PERMIT TYPE -BUILD TITLE NEW RESIDENTIAL BLDG PMT CONTRACTORS: PROPERTY OWNER Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $358.36 THE BOND $.00 Ox CONSTRUCTION COSTS $115,600.00 101 SINGLE FAM HOME DETACHED 1 PRIVATE R14.PL�i * BARMABLE, MASS. 9. BUILDING DIVISI0 },`•�BY - DATE ISSUED 03/04/19S8 __ I RATION DATE- �__ -- TOWN\j6T ADDREISS 18, 011E LANE " ' , W� � --P1JONE BLOCK DBE "6 _ DEVELOPMENT DIS1..kT-0` � �ION N A :P RNI 9247 V 3P 1,I �I zlVG"�F M •� �+ I�C2 B+ 8�+1n���, PERMIT TYPE'_"- .t 1LD TITLE I!�EWjRESI ENTIAL l�LDG P T >: 'CONTRACTORS: PROPERTY OWNS ;. } ',' Department,of Health, Safety and En ironmental Services TOM, FEES $35ff.36 BOND $.00 � if �TME �fr CONSTRUCTIOU COSTS 1.1.8 0€600, .1� k 1.01.' SINGL d4 P HOME DRTACBED 1% PRIVAT P f 14$ 1BIA a. r, "E £ZBI1IL`DING DIVISION r BY Ia&C :I�S ED 03/04/1. 9B EXPIR 10. THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,.EITHER TEMPORARILY OR PERMANENTLY. EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS' THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE EPERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU-. ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS • BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS • • G� ,ems 2 � 2�,1-Z.4-wig 2 1 HEATING INSPECTIO PPROVALS E [NEE ING DEPAR NT 2 �p -Z., _9 1 ` ��� BOARD OF HEALTH J OTHER: SITE PLAN REVIEW APPROVAL f7c�ss 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. k I BUILDI NG PERMI T TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL, ID 021 101 GEOBASE ID 1011 ; ADDRESS IS JULIE LANE PHONE COTUIT ZIP - �.LOT 5 BLOCK LOT SIZE DEA DEVELOPMENT DISTRICT CT ERM 1 TLEIPTIOA TFTLODWELLING O C BLD PER 29247) ., PERMIT TYPE B000 IT CER ICAEFUPANCY CONTRACTORS- Department of Health, Safet; ARCHITECTS: RP` And Environmental'Serikes ' TOTAL FEES: BOND ECONSTRUCTION COSTS' $.00•. 753 MISC. ,NOT CODED ELSEWHERE , 163 MIS BUILDMI S N BY DATE ISSUED 05/11/1999 .' EXPIRATION DATE„ THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY.,STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED APPROVED PLANS MUST BE RETAINED ON JOB AND FOR ALL CONSTRUCTION WORK: WHERE. APPLICABLE, SEPARATE. THIS CARD KEPT POSTED UNTIL FINAL INSPECTION 1.FOUNDATIONS OR FOOTINGS PERMITS ARE REQUIRED. FOR 2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU= ELECTRICAL,PLUMBING AND MECH- (READYTO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL N.OT.BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 e.:Fo 3I y� p r EATING INSPECTIO PPROVALS E INEE ING DEPAR NT 'Z,q ,g� Jl��r BOARD OF HEALTH 1 = OTHER: SITE PLAN REVIEW APPROVAL #sh I 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. 0� Western Surety Company . A Subsidiary of CNA Surety Corporation May 3, 1999 Agent Code: 2000819 Building Inspector " Town of Barnstable Town Hall Hyannis, MA 02601 r Re: Bond#42690000 - William-J. Rogers 77 Queensbrook Rd. Pembroke, MA 02359 $1,000 - Street Permit - Town of Barnstable Project Address: 18 Julie Lane, Barnstable, Village of Cotuit, MA , We wish to take advantage of the cancellation provision pertaining to this bond or policy. You are hereby notified that this bond or policy is cancelled and voided as of June 6, 1999, or the earliest time permitted by applicable law, whichever is later. This bond or policy has been cancelled or nonrenewed because of the following reason: Nonpayment of premium. cc: Hannon-Ryan Insurance Associates, Inc. William J. Rogers • d _};. u..�. .,...,,s.;.�.f_ �Ir ��. ,:.$:. r;. t ' `.rw S. %.",1.."... - -.�,..X_, .A �:. `�X6: r , • SINCE 1900 - r 1-800-331-6053 P.0.Box 5077 FAX 1-605-335-0357 Sioux Falls,South Dakota 57117-5077 http://www.westernsurety.com _ LOC� i C ' I O °° AS. BUfL ' L01- 5 (IOU 18)JULIE LANE FOUNDATION PLAN COrU11= GSARMSTABLE MA. SCALE 1'`-4-0' DATE 4 /10/9 PkIePARED FOR :' f - C _FOfJtJDATl-G-K (r. v' _N_S.E_ GA�t a �` Joel L. 'Martin of 205 `Drew e v q .naa (' JOEt �G`\ 8;l LLEWEjAkL.ILYN etc B r'ockton, MdSS. NO. 27.493 • . I.Cevid�Oast +he ��und; on wad ���4G St1RvE�.`• �* rn sfa l)c d as shown 0" +b j s � . Engineering.Dept.(3rd floor) Map Parcel /61 - - Permit#, House# B Date Issued i Board of Health(3rfifloor)(8:15 -9:30/1:00;4:30) -36 _Conservation Office(4th floor)(8:30-9:30/1:00-2:00)J Planning t.(1st floor/School Admin.Bldg.) C SYS UST BE E® IANCE V�vepproved by Planning Board ���+ '=���7 19 (, ;, WI ONM E'AND TOWN OF BARN$TABL TOWN R I ON$ Buildin P rmit Application AWN dress - .. Owner Address-. ,Telephon / 6�2-3 S3 / x �Q i-0167, Vyt +Permit Request First Floor 6 square feetsquare feet Construction Type 40 BUILDING DEPT. ® Estimated Project Cost $ / GyG, FEBF 271998 Zoning District �/� Flood Plain W Protection Lot Size Grandfathered ❑Yes ❑No E C Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure,.-jq � Historic House ❑Yes o On Old King's Highway ❑Yes No Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New �— No. of Bedrooms: Existing . -3 New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type an7es ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No P g g Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ttached(size) 02 ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ 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# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ' SIGNATURE LIZ; DATE BUILDING PERMIT DENIED FO .T FOLLOWING REASON(S) C/ }j Sk t f ` FOR OFFICIAL USE ONLY r _ PERMIT NO. DATE ISSUED ? : } •_� _-' - t � �' .. 3 • - � .... R_ ,) 1 MAP/PARCEL NO. ,. � � � ' •�_ -, ' t r �, � .~ , ADDRESS 't VILLAGE OWNER DATE OF,INSPECTION: t I FOUNDATION FRAME, INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ^;ROUGH-• FINAL r•-9~- ,� GAS: s I"IUG FINAL rrl _' co J . FINAL BUILDINCa 0 F. " 3 IT, ca Mn in DATE CLOSED OUP m� ASSOCIATION PLAT N� n2S f M NOV-25-1998 08:58 WOODSTRUCTURES 2072862835 P.02i02 928851 009REP FINK t' v •__-_ e d, t o n ustrtes, ne. °' w ag° -WOOD STRUCTURES lNC,, D.M 8-11-13 13-0-0 19-0-3 26-0-0 27-6-1 6-11-13 6.0 3 6-0-3 6-11-13 1-6-1 ATTACH vr TR RATED C1LP 1) TO EACH ACE OF TRUSS WI GLUE AND 11 COMMON"RE NAILS (.14r DIAX31)( RNEN THRU&CLINCHED)SPACED 3'O.C. 24"X24" OTOTAL NUMBER OF NAILS PER MEMBER (DIVIDED EQUALLY BETWEEN FRONTS BACIQ 4X5 - (TYP) Z- 6 4 6 FACE GRAIN 3A 5 ADD 2X4 SPF NO.2 8.00 FTF CUT TO FIT TIGHT " 1x4 jl\ 6 6 6 10 II 6 3 9 01 7 6 e 1 .- q� -----•-------- --------------- 9 d 3x4 i�3x4 3x4 O3x4 �� 15 16 14 6 3 12 11 10 17 18 axe I 3x8 � 30 - 3x4 = r12"Xi Gr ECTION TO BE REMOVED J NEW BEARING LOCATION 8-3-0 11-4-0 1?- 0 17-0-0 17-9 26.0-0 &3-0 3-1-0 D-8-0 5-0-0 6-9-0 B- ate Offsets LOADING (P�) SPACING 1.1.8 CSI DEFL (in) (loc) tldefl PLATES GRIP TOLL 25.0 Plates Ineroase 1.15 TC 0.39 V°K(LL) 4,08 8-10 ;999 'M20 189/189 TCDL 7.0 Lumberincrease 1.15 BC 0-34 Verz(TL 0.03 8.10 BCLL 0.0 Rep Stress Iner YES we 0.42 Harz(Tl) 0.03 8 �a Weight 121 lb BCDL 10.0 Code BOCA/ANSI95 (MaW 4 1 st LC LL Min Vdefl=240 9 L BRACING UMBER TOP CHORD 2 X 4 SPF No.2 TOP CHORD Sheathed or 6"on center pudin spacing. BOT CHORD Rigid ceiling directly applied or 8.0-0 on center bracing. BOP CHORD 2 X 4 SYP No.2 WEBS 2 X 4 SPF No.2'Extxpt' WEBS 1 Row mldpt 4-13 3.14 2 X 4 SPFS Stud,6.10 2 X 4 SPFS Stud SUDER Left 2 X 4 SPF No.2 4.1-0,Right 2 X 4 SPF No.2 4.1-0 REACTIONS (lb/slze) 1=231103b,8=38810.9-e,13=70Bf0.3.8 Max Grav 1=2810oad cam 2).8=3860oad case 1),13=708(load case 1) H ' FORCES (Ib)•First Load Casa Only ASS TOP CHORD 1.2=-193,24---136,3.4=-144,4S=•187,be=-271,6.7=•20b,7.8=341,8.9--21 .�� S EVE BOT CHORD 1-15=1 18,15-18=118,14.16=118,1314=•145,12.13=D,10-11=0,10.17=221.17.18=221.8.18=221 WEBS 3-14=-247,4-14=438,4-10=353,8.10=230,4.13=-732 U 0 NOTES N 1) This truss has been checked for unbalanced loading conditions. -a / 7240 2) All plates are M20 plates unless otherwise Indicated. 9 3)This truss has been designed for a live load of 20.Opst on the bottom chord in all areas with a clearance greater than 3.8.0 between FGISTEP�,�t��Q the bottom chord and any other members. 4)This truss has been designed with ANSVTPI 1.1095 criteria IAL E�G\ LOAD CASE(S)Standard A WAM MM-Verft desfdn paraaseters and READ J9Q M8 ON TWS AND REVMRS6 SWX BEFORE UIIBE. component to be pesign vales far us*only will M(fsk connectors.ihls design b based only upon parameteo Mown,and Is lot an htlivldual busding Inslaued and loaded wrtloolly. Applicability of design parameters and proper Ineorpolailon of component Is respalslbWlY of building deslgTler'not oust tlesgner.Braetnq Mown Is for bfetal support of individual web membets onN•Additional lempotaty bracing to Insure stability during construction!the lesponslblilly of the ereota.Additional permanent btodng of the overas Nructure k the responslblNly of the building designer.Fat general guidance 91 regadln0 lobrleafbn,quality oonllol sfaage,denwry,erection and bracing,consu8 08T•88 Ouatey,standard.DSI.69(racing apecelcatlon and Mls•el �.......,,n..A%.ache 0eeemmwWailen avasable from hues Plate Instlluls,58.9 O'Onohb ONw,Madison,WI S971V, TOTAL P.02 ..ow { I. f `12 j SNMGLES - SHMES g pD RAKE BOARD -----_.. i SNWGLES -- - '- ___-- 5/4W TRM BOARD hD RAKE BOARD SAW TRIM BOARD . ------ - -. .._- LA Q METAL ORP EDGE --- ® r LID FASCIA BD 9 ...---FIASRIFl� ..-`----- =1---- MO FREE BD -1€VHID3DIFC-B'F1ZTD�€ ---- -- LEE ---r- :4 .. . CONCRETE STEP I R i - - - — — — — — — — — — - — — — — — — — — — — - — — — — — — — — — - — — — — — — — — — — — — — J 1 — — — — — — — — — — — — — — — — — — — - — -- — — — — — — — — — — — — - — — — — — — — — — -- — — — s — J...:— - 1.. L — — — — — — — — — — — — — — — — — — —C— — — — - — — — _ - - — — — — — — — — — — — — — — — J ; FRONT EL -EVAT 1 0 N SQv SCALE 1/4' - T-O' � 1 - - SHINGLES -------- ---- - SHINGLES 24-12OW8'wD LOWERED VENT SHBi(LES - --- _ - dD RAKE BOARD Y --- - - 5/4 x8'.TRIKA BOARD WTAL DRIP EDGE b0 FASCIA BOND ---- — t t4 I t 2t ----- ---.._._.---'---....__._ �F F -- AETN.DRIP EDGE — -- --- - FT h0 FASCIA BOND 7-01 SLI M GL _ 75 - 2xY --- - _ _ a --- — - Y ------ — ^" - — T .. -S EPS I _' R I 2 OONCfiETE 2 CONCRETE STEPS L I I _I - - - -- - - - - - I I I - - - - - - rJ - _ - _ _q J i- - - - - - - - - - - - R E. A E L E V A T 1 0 N SCALE VO T-O' s - h1D RAKE BOARD , --- � S/4k8'TRRA BOARD F ,. SHNGLES 51 BUILDMG FELT 12 t --- _...._..---., SADDLE - SHNGLES ------- . kETAL ORD EDGE - --=--"-------------....-_.--,_...__._. tr8 FASCIA BOND --'-----' -- _._.__—' — --------------' -—.._._..—._ -. r i r..-8 -. ..__..___..... I LL LIIS-ij I <I. - - } — — — — — = - — — — — — — — — - — - — — — r _ t ` — — — — — — — — — — — — - - — — — — — — — — — — — — — — — — — — — — — RIGHT : .-E . LEVA' T. 1 0N. 24*001Q8'WO LOUVERED VENTS } SHINGLES .; - - a '-r UD RAKE BO - 4 5/4k8'TRIM BO - 5•BU0.0MG FELT SHDQLES , I t - - - i ! H 11 .. 3 LL I —JJI I L` I —JJI L 2M FLAGST SEL I' WTN_ AREAWAY — - — — — — - — — — — — — — — — L — — —- — — — — — — — — — — — — — — — — — — - — — — — — — — — — — — — j r: LEFT ELEVA -T1ON w Y s , TERRA! S TER ow arcs - ,� s .�,...c��.—L sL•e a ss o.n w.�w "e �- - - i -T .F�•waE.L.,. —°' DININ° RMI * 1 BEDR00M R I 1 Y Y - : �I I -, Fs I' —= mEcwFEEnm vnssEs .'uc. \�� �i ` �i } ✓I ' ATTIC - x.e L ] °uL'no te®w+°rE aawP'oaM0.r a � `•TT ITCHEN 0 - _- . mEEn ]-0„ K gi v°o SERV. ENTRY j-....GARAGE i'. dEx]..x x•on LAUNDRY SERV.ENT. �u,] O � Fu� � • �jl 1 i bm&�'"� — F f _ .•ous E 4• a rr - e'r� - ® -e•,vr� a z ,].�. y ; eR - vya•az aa: L_ ,� BRKFSTPRM a EOOT �, is s ,• I. p-BASEMENT r § C 1 I g'WII - COVERS PORCH r II STOR UDFQ-yT ctT,K w®pa " sse°•,eb6.r uiaae+h?'K•:.r° - _ +` BED D -T- ___=BEDTROOM • _ 'rpV fLal w.4Q.p FErmF mr.uEua I II • G" ARAGE SECT 1 0 N A-2 A-2R SCALE :3/6. T-0' m'o +a,j� F IRST FLOOR PLAN • - � � � SCALE v° E-0 LIVING AREA 1830 SO. FT. BUILDING VOLLIME 47335 CU. FT. M. 2947 , as. 4 n 0, ZP V F x4 _ yq v P I I Te- e't- s.a aw.;a,.re - _ �a.e.•s,e£a.�, _ �310 vm ai'— n t _ _ BASEMENT - --, Ulf I 1 -n YT ebb'Dl� MiF 1 1 _ mexrc •DNEXCAVATED w $� UNECAVAeTED C:2 P L 0 T P . LAN b °w NO SCALE m _ F 0 U N D A T I 0 N P L A N- W, - SCALE VV T-O- /III/// �\ ^� s �'qP t`D 0 u 4 r,r PLANNERS,INC 2947 The, Cotlttttottivealth ofalassachmefls Department of Industrial.-Iccillel is vN efifh7YeStlyatJonS ' 6110 ff•ushia";tonStreet Boston. A1a.Ys. 02111 Workers' Compensation Insurance Affidavit Itcant information': Please PR11VTleb' �7_ ✓ cat' n �3 C I am a homeowner performing all work myself. [1 I am a sole proprietor and have no one working= in any capacity [! I am an emplover providing workers' compensation for my employees working On this job. cnrnttatm• narne: adrlress: ' cite: ithnne#• . insurntice rn. nnlicv# 1 am a sole proprietor, general contracto or omeowner rcle are) and have hired the contractors listed below who have the Following wor�k`e'rs©compensatiiioon polices: ,/� 'cmmn:rni' nnmc: ;/— /l "/ / it1 _ Y � � trlrirc«: e-7 th f l T 1 It-1 136 (t cir� F E 1-, �n Q u T h Kniq S V ph—one#: r1'A 14 ^. incurnncr ro Nlr err t� c�OC\G1LA a R U L—�S nnlic.•# `l BUR -,2iLl4 )k-1449 Cnm nnc• nntnr•: �addresc ill 0 n �� e�ritc: rhnnc#: insurance en. policy 0 Attach additional sheet if neces_sarv�- ^- + --�� •�� _ _ __"" "e�'~- •• ti--y ram- -, _'-- Failure SC Cure cucerace as required under Section.SA of AIGL 152 can lead to the imposition of criminal penalties 01•2 line up to S1.500.00 andiur une�cars' imprisonment as Well:ts civil Penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. i understand that a cope of this atatentcut mac be forwarded to the OMce of Investigations of the DIA for coverage s•crification. 1 do herebr cerri.- -rt der the pains and penala• f perjun•that the information prorided above is true td correct. Signature Date ` Print name Phone# official uc only do not write in this area to be completed by city or town official *` city or town: permit/license# r1guiiding Department CLiccnsing hoard rr 1] check if immediate response is required Selectmen's Office f t [31lc2ith Department contact Person: phone#: rj0thcr .i Information and Instructions Massacl'usetts General Laws chapter 152 section 25 requires all ern plovers to provide workers' compensation for th employecs. As quoted from the "law-. ail empinree is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An emplt rer is defined as an individual. partnership, association. corporation or other legal entity. or anv two or me the foregoingenuagcd in a joint enterprise, and including the le al representatives of a deccasctl employer. or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However,; owner of a dwelling house haying not more than three apartments and who resides therein. or the occupant of the dwcllin�,, house of another who employs persons to do maintenance , construction or repair work on such dwelling_ he or on the _rounds or buiiding appurtenant thereto shall not because of such employment be deemed to be an empioye MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for anv applicant Nvho has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to ;your situation and supplying_ company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "taw" or if you are require. to obtain a workers' compensation policy. please call the Department at the number listed below. City or rowns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ph be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless otherarrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questic please do not hesitate to __ive us a =11. ...y,.....+..• _-.....�-..,.-. .�.....r.+-•.: �..v�-� •-�.�..�•r�w.w+�+�. ... ..�.+...�w..w...�e.rv�7r'•r, v.���r��•i The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 «1I) 777_.19nn .vt. 406. 409 or 375 A . • TOWN OF BARNSTABLE ' . . .BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION P ease print. DATE JOB. LOCATION �o7o /7 Number Street address Section of town "HOMEOWNER" Po C C 6- r ���1� �q .3-J_.3 Name Home phone Work phone - - :PRESENT MAILING ADDRESS 7 l City town State Zip code The current exemption for "homeowners" was extended to include owner-occumiE dwellings of six units or less and to allow such homeowners to engage an in- diviJu'al for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re side, 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 Offic on a form acceptable to the Building Official, that he/she shall be resuonsi. for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the S Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirem* enta and that he/she will compl w' said procedures and requirements. HOMEOWNER'S SIGNATU APPROVAL OF BUILDING OFFICIAL ote: Three family dwellings 35 , 000 cubic feet, or larger, will be required 0 comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a persons) for hire to do such work, that such Home OwnE shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for . licensing Construction* Supervisors Section 2. 15) . This lack of awarenE often results in serious ,problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home '•Owner.' act_ as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, ma.- communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. _r. :'..."........A..... � :�.��:�:/:::�::�IJ ::::1::::�t:::: iR::E: :: :� R�:�:ltiiilz : <::>:�: ;. :: :::..' �i✓: <::>:!<><:<:s:>`<::>::.;:.;:.:;.;:.; :'. A CORD :.::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.:::::::::::::::::::::::::::::::::::::::::::.::::::::::::::::::::::::::::::::::::::: :: :._::::._.::::::::::::::::::::..::: 02 24 1998 .PROD...ER::;:.:::.................................................. ::..::;FAX''':::. (5 0 8)5 40-2 400 (5 0 8)5 40-66 71 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE urray & MacDonald Insurance Services HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 406 ]ones Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Falmouth, MA 02540 COMPANIES AFFORDING COVERAGE .......................................................................................................................................... COMPANY Travelers Assigned Risk WC Attn: CIC, Maureen Souza Ext: A .............................................................................................................................................................................................:........................................................................................ ...................................... COMPANY Frank Silva Concrete Forms B 27 Misty Harbor .................................................................................................................................................... E Falmouth, MA 02536 COMPANY C ..................................................................................................................................................... COMPANY' - D GAR#DES[::>:«:«::><:'':'.»:>......................:>:::>:::>:::>:::>:>:::>:::>:::>:::>:>:>;>::>:<::>:>::<::<:> :>>i':>:><:>::>:>z:>:>:>««:»zz;>:>:>::<:>''»:>'>:>: ::::<:>:::>:::>::>:::>::::[:::>::>::>`>:::>:>:>:>:............................................................. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ,;: CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .................................................................................................................................................................................................... ......................................................................................... CO TYPE OF INSURANCE POLICY NUMBER i POLICY EFFECTIVE :i POLICY EXPIRATION: LIMITS LTR DATE(MM/DD/Yl() DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ .... COMMERCIAL GENERAL LIABILITY i PRODUCTS-COMP/OP AGG $ ......................................... .. ................................ ........ CLAIMS MADE :OCCUR'. PERSONAL&ADV INJURY $ OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ ......... ; .............................................. ................................. FIRE DAMAGE(Any one fire) $ ............................................................................ _...:......._............_...__.._...._.....__... MED EXP(Any one person) $ ; AUTOMOBILE LIABILITY ANY AUTO _ COMBINED SINGLE LIMIT COMBI $ ........., ...................... .................................. ALL OWNED AUTOS i BODILY INJURY $ SCHEDULED AUTOS (Per person) ............... . ...................... .............................. HIRED AUTOS '• BODILY INJURY $ NON-OWNED AUTOS (Per accident) ....... .................. ........................ ;' i PROPERTY DAMAGEi $ - GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: ...... EACH ACCIDENT $ ........................................................................................ AGGREGATE: $ EXCESS LIABILITY EACH OCCURRENCE $ ......_................... ................................ UMBRELLA FORM AGGREGATE $ .................................................................................... OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND TORY LA I IMITS is ' ................................ :: :: ER .. .EMPLOYERS'LIABILITY ... .. ..................A ;THE PROPRIETOR/ '.7PUB344X748-A 12/30/1997 ;: 12/30/1998 ':.ELEACHACCIDENT $ 00,000 PARTNERS/EXECUTIVE ;,,,. INCL. : " ! EL DISEASE POLICY LIMIT $ 500,000 ..... OFFICERS ARE: EXCL i EL DISEASE-EA EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS oncrete forms :•::::::::::•.::::::.::::::.:::......::...::....................................................................................................... ...............................................................................................................X.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL IQ_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, William Rogers BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 77 Queens Brook Road OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. Pembroke MA 02359 AUTHORIZED REPRESENTATIVE p CIC, Maureen Souza/ A ' .: #� +. ..! ��;<<:<:'<:':::::::>':>'::>>:><:>«<:»»:<<:»»>:>:>::::>.':::> > ...... :: :: ::::>:......«:::> :><<::::' «:::>::':<`;:<:<<:'«:':' ::«:>`; :'>:.? ::<:«?:<<: tG:Q# C.... C JiiTtQisf... >x8 5 1110�c TEA, No 1.11C.A L E TOP FNON. FINISH Gf-?ADE OVER FINISH GRADE EL . 7 FINISH GRADE FIN.,"SH GRADE OVER OVER TRENCHES DINT. BOX SEPTIC TANK 77ANNY 12 MAX. 0! A.Y,Z,;J.0 TOTAL LENGTH OF TF!ZN,,'I-1 OUTLET PIPE LEVEL 13 FOR 2 FT. MIN. ja 0,, C. I. OR PVC TEES r= 0 h v 1500 GA L ,L 0,1V BSM T FL .50 0 GA L ON DP MEL L S rr !,OLYS7, JN A_� ZV BASE c, ul v 4,or'—j'L j L �b C, 13, SEP T_ -/-/L, A INS TA L L ON L E VE L &A L014EA' TO F0404T ALL .�-'iPEP110US 77/MW Y// '=n r,m M z/v. ', EPIAL &EWEA Tj'-j' TiLif LEA CHYA!6, A Pf,4 4 DIA M. OF 1/49 ;,,"CA VA. TED AfA ',-Ec.11AL WITH j 12 Q*clk� 3 o., SAND YA SHED PEA S TONE V HJED - 314" 1-112" )iA'SHE;"D ......... ........ CRUSHED STONE ,__ 45). TRENCH #_:,J TH 4 1-L M _,W_ W ARE SEO ON A SS 14ED MUM&EP, OF T-7ENCt _Jl�m Hb-�;T 3E illkj?lh�__7rl;, OF DP YNEL L 5 2 ll�e 4­d BE NO TIF_.,�,D IrS -iEN 0" S _N OP L E TE PRZ AT To &A CKFIL L PZPCO' RA TE.* A,10 <2 A,;' 7,A�,'.11N. 4. 4WY ,',4i,41V(3E,5 71' THIL" MUST BE APP:iOVED 21 d.1 TNE.�;SED 8 Y' 74 �-IEALT�-,! AND CAPC & ISLANDS N INC. FDWA PEI -ALS IA,STA LL,,! T..,"5N SHA L L BE IN BFID. OF HEAL TJL1 0 FESIGN DA TA q TA SA N1 TAFFY L 'LAL APPLICABLE DA TE: co C05IC TZ7L,­ AN- L/ RUL E,` A;}°D 7'/ 3 LA ' Fl_1_JPD PLANS AND 4 NUMBER OF BEDROOMS do - it y,z Ir- IrYR -1/2,v1 6. NORTH APPOW Yt� FP`4 12" GARBAGE DISPOSAL NO I Nc ­4 SOLAP PUPPOSES TO &_ /, 7�_g jc",_a, _s,,A 330 SAL . 'rL Y FLOW 'IQ 7. FL OJD i-JAZAR-) 3NE ZA PD) DA., J. YA T 1500 GAL . E,':? SUPPLY T ;0111V WA TER Z"C TA 1VK RE® 'D. In Y R 6,/p St Tl 1 x5oo GAL . SEPTIC TANK PRO✓VIDED 21�2 c_ LEACHING PEOUIPED 330 GPD. SIDEWALL AREA = 152 S. F. 112 GpD. -152 S. F. 1_!2_2461S.F. 80 T TOM AREA — 329 S. F. i `� i \ �� \ ti ' 32-95. F.X 0. F. = 243 GpD 1 '� oo / / p ,., Nn <j r r/w r L EA CHING PRO VIDED = 355 GPD PR,,POSED j 1 7 j I E VA TION 'STING CWTOUR 00,14ER VA 'T. ON Pr T DI,,'TRICUTION BOX N PRC `JSED SEWA GZ DISPOSA L S YS TEM IC LANE jUL_ tZ Z"!=L PF'.`_:7PA PED FOP 0 T (H0J3Z 43) JUL ZZ LA NE '0 TUI T i-,:-'A S TA 3L MA 55 . P .,- 1W lEf,"I'" ELEVATION yty,in :.J DA T CA Pam' ISL A IVDS E71YGINEEPING 3 3 7 PLOT PLAN r l SC,4 E A S A/0 TED 3 FA L IYOU TH RJA D — SUI TE 2E SCALE: I AIA SHPEE, MA S5. P4_rl_4A" NO. )'EC pce.