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Home My WebLink About1665 MAIN STREET (COTUIT) _ __ _. r �o:�s r �� . _ _ � �� w �� i �, - � , � v _ - _ _ . L �--- Town of BarnstableBuildip • 'Post�This Card So That it is Visible From the'Street-Approved'Plans Must be Retained.on Job and this Card Must be Kept t •nRNnAat MAS& IPosted Until,Final Inspection-Has Been Made. Where a Certificate of Occupancy is Required,such Buildmgshall Not be Oceup►ed.,until aFinal ans ection has been made LL -.� ._. .w� _, _ p eY'm ir Applicant Name: Michael LeBlanc . Permit No. B-20-2334 Approvals Date Issued: 08/25/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/25/2021 Foundation: Location: 1665 MAIMSTREET(COTUIT),COTUIT Map/Lot:, 017-002 Zoning District: RF Sheathing: Owner on Record: GOMEZ, BENJAMIN A&CABLE,SUSAN W ; 4' Contractor Name*" MICHAEL LL LEBLANC Framing: 1 Address: 48 CRANMORE ROAD p' Contractor License CSFA-057337 2 WELLESLEY, MA 02481 „ � Est. Project Cost: $5,000.00 Chimney: Description: REMOVE AND REPLACE TWO WINDOWS IN FRONT OF THE HOUSE Permit Fee: _ $35.00 IN THE LIVING. ANDERSON 400 SERIES UNITS,CONISTING OF 2 Insulation: DOUBLE HUNG AND 1 TRANSOM. SAME SIZE-AS EXISTING IN NO Fee Paid: $35.00 CHANGE TO OPENING. Date. 8/25/2020 Final: x f _ Plumbing/Gas • Project Review Req: z Rough Plumbing:. Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage'Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final; All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT S� y Town of Barnstable Building rsra�s.E. ) Post This Card So That it is Visible from the Street-Approved Plans Must be Retained on Job and this Card Must be Kept POsted,Until-Final Inspection Has Been Made, p yam f+ b ®` lWhere4i Certificate-of Occupancy is Required,"such Building shall Not be Occupied until a Final Inspectiort hasbeen made'. 1 �i Inn 1 Permit No. B-19-2400 Applicant Name: Michael LeBlanc Approvals Date Issued: 08/02/2019 Current Use: Structure Permit Type: Building-Deck Expiration Date: 02/02/2020 Foundation: Location: 1665 MAIN STREET(COTUIT),COTUIT Map/Lot. 017-002_ Zoning District: RF. Sheathing: Contractor Name: ,,LEBLANC BUILDERS CO. INC. Framing: 1 Owner on Record: Benjamin A. Gomez and Susan W.Cable Address: 48 CRANMORE ROAD Contractor License: 104364 2 WELLESLEY, MA 02481 - Est. Project Cost: $8,500.00 Chimney: Description: replacement of balcony style roof deck(OVER PORCH ) located at Permit Feb: $ 110.00 the front of the house(SEE PHOTO. Issue is a eak and damage. Insulation; Includes removal of existing damaged deck boards,frame,£rubber �w Fee Paid:" $ 110.00 Date: 1 8/2/2019 Final: roofing under the deck boards. Replace existing damaged frame, _. M. - rubber roofing,'new decking and new railing system to code. Plumbing/Gas Project Review Re Rough Plumbing: -- — � Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afterissuance. All work authorized by this permit shall conform to the approved application and the approvedconstruction documents,for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for�public inspection for the entire duration of the Final Gar. work until the completion of the same. _ Electrical ,. . , The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection - ' 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site / Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT s � - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map / Parcel Application Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 00 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street.Address WLA- Pt 4v Village C®,v►,�{' Owner_ 2c�Q T?A F)i1 ;r,1 X° Address (-co Co S #t (;T- s— Telephone 'Z rt I i fe Permit Request btr rry-Z_ L_A-".,J V 6=1 r-t o-c^-r' w AT5 HZ,.2 ®fEl-V�� Square feet: 1 st floor: existing 2 proposed ® 2nd floor: existing ZQo� proposed O Total new y Zoning District Flood Plain Groundwater Overlay Project Valuation °7-0. 0-o() Construction Type W°v47 A '" Lot Size ( .vG Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure `t X-S Historic House: ❑Yes >6LNo On Old King's Highway: ❑Yes )§*o Basement Type: ❑ Full Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) 0 Basement Unfinished Area(sq.ft) 7-0-oO Number of Baths: Full: existing new n Half: existing f new 0 Number of Bedrooms: existing -onew Total Room Count (not including baths): existing new 0 First Floor Room Count Heat Type and Fuel: ►Gas ❑Oil ❑ Electric ❑ Other Central Air: Y,Yes ❑ No Fireplaces: Existing 'k-- New O Existing wood/coal stove: ❑Yes S No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn:0 xi sting^:-Q ne8 size_ Attached garage:$%existing 0 new size Shed: ❑ existing ❑ new size — Other Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes $No If yes, site plan review# Current Use Proposed Use a APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ycK'-VLT.-4`f 1I;u,t-Dr_45 1,4C Telephone Number Sr6 1 - �o 2— Address o 75 C 4-Lo License# 8)4-1 �S3 Home Improvement Contractor# I S q Worker's Compensation # 9'Tw` 46 a q b ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO `5 ra-R ,-7-1&t SIGNATURE ( �`ck DATE JIq 'f'f f j ' FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED - r• MAP/PARCEL NO. " t - ADDRESS VILLAGE }' OWNER DATE OF INSPECTION: FOUNDATION '+ FRAME j3 D INSULATION 0h 113 ly FIREPLACE ELECTRICAL: ROUGH FINAL " PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 4 S The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IYj 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print .Legibbl Name (Business/Organizatiorillndividual): v�,.l ✓`1e� ��'°I �� S LEI G Address: °Pa rl -ac c City/State/Zip: Ct9 1 0.2—Gj5 Phone #: v�efr - tf-t'1. Sr4 f�:Z Are you an employer? Check the appropriate box: Type of project(required): 1.[19 I am a employer with 34. [] I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors ❑ 2.❑ I am a sole proprietor or partner listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. 0 Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp. insurance. required.] . F] qu 10.❑ Electrical repairs or additit 5 We are a corporation and its 3.El I qu a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additit myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs required t c. 152, §1(4),and we have no insurance re q ] employees. [No workers' 13.❑ Other comp.insurance required,] *Any applicant that checks box 41 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 not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: l>l.e MHz> t t-L S,u C_&r LC 26 ct- — Policy#or Self-ins. Lie.#: Sr wc, at a Expiration Date: i��0 5 Job Site Address: n_-, rA 15 i - City/State/Zip: C0 .T ✓ua DZw� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct. " Signature: Date: r�` Phone.#: 0 -4'1-7 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# . Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing,Inspector .6. Other . Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under.any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth'for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." .. Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants situation and if affidavit completely,b checkin the boxes that apply to yours , Please fill out the workers compensation Y g PP nece sa supply sub-contractors names address es and hone nurriber(s) along with their certificate(s)of s D', PP Y. ( ) ( ), address(es) P insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry-workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit.. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. 'Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed_ below. Selfinsured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the.applicant. Please be sure to fill in the permit/license number which will be used-as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stampedor marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required.to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 ` Revised 4-24-07 www.mass.gov/dia DATE(MM/DD/YYYY) A CERTIFICATE OF LIABILITY INSURANCE 02/28/2014 THIS C RTIFICATE IS ISSUED AS A MATTER OF INFORMATION'ONLY AND CONFERS NO RIGHTS UPON'THE,CERTIFICATE HOLDER.THIS. CERTIFICATE DOES NOT AFFIRMATIVELYOR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE-AFFORDED BY THE;POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT,:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION'IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement: A statement on this certificate does not.con%r rights to the ' certificate holder in lieu of such endorsements. PRODUCER CONTACT Paychex insurance Agency Inc PAYCHEX INSURANCE AGENCY,INC. 150 SAWGRASS DRIVE PHRNNE6. 877_266 6850 F 585-389-7426 ROCHESTER,NY 14620 EMAIL Certs@paychex.com INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: NorGUARD Insurance Company 31470 STEVEN MCELHENY BUILDER INC INSURER B:, P.O.BOX 460 COTUIT,MA 02635 INSURER C INSURER D: INSURER'E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 7j 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. NS TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EPF POLICY EXP LIMITS LTR INSR D" (MM/DD/YYYY). (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES(Fa dc�yrcence _ OCLAIMS-MADEE::]OCCUR - MED EXP(Any one person)' . PERSONAL-&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG, $ POLICY PRD,IECT=LOC - - $. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ' ANY AUTO -ALL OWNED SCHEDULED - i BODILY INJURY - $, AUTOS AUTOS (Per person) HIRED AUTOS AUTO6WNED 'BODILYINJURY I $ _ -. (Per accident) _ .PROPERTY DAMAGE' ,$ (Per accident) i $ UMBKELL LWB OCCUR EACH OCdURRENCE $ EXC $ ESS LIAR �CLAIMS-MADE AGGREGATE- � DED RETENTIONS - $ WORKERSCONIPENSATION AND X WOSTATUr 1 STWC580819 01129/2014 01/29/2015 €MPLOYER$LIABILITY - , - E.L.EACH ACCIDENT $, 160,009.00- A14Y PROPRIETORIPARTNERIEXEOUTIVE OFFICER/MEMBER EXCLUDED?. �_y/N E.L.DISEASE-EA EMPLOYEE $ 100,009.09 (Mandatory In NH)' N/A E.L.DISEASE-POLICY LIMIT $ 500,000.00 If yes,describe under 1 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(Attach ACOR0107,Additignal:Remarks Schedule,it more space is required)' CERTIFICATE HOLDER , CANCELLATION Steven,McElheny Builder Inc SHOULD ANY OF THE ABOVE'DESCgIBED POLICIES"BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE"POLICY PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND,UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE. ACORD 25(2010/06) 019116.2010 ACORD CORPORATION. All rights reserved: The ACORD-name and logo are registered marks of ACORp Ulae�o�r�vaao�rzcueaC�o�C�aac�urJeCta-s Q\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration , 157699 Type: Office of Consumer Affairs and Business.Regulation Expiration K 10/291.2015 Private Corporatign 10 Park Plaza-Suite 5170 - Boston,,MA 02116 STEVEN MCELHENY BUILDERS INC STEVEN MCELHENYc� 5 56 BOWDOIN RD. MASHPEE,MA 02649 Undersecretary Not valid without signature Massachusetts -Department of Public Safety ' Board of - Building Regulations and Standards Construction Supervisor 1 &2 Family License:CSFA-047693 � STEVENP MCELI�ENY'' ; PO BOX 460 r Cotuit MA 02635! Expiration Commissioner 09/23/2015 ,..._: 9 - 1 r ` awn of Barn-stahle Y Y Regulatory Services Thomas F_ Geiler,Director 4' Fnµ �•� Building Division Toni Perry, Building Commissioner 200 Main Strcet, Hyannis,MA 02601 )VWW.town.b arnstable.tna.us Office: 508-862-4038 Fax: 508-79( Property Owtier-Must Complete and Sign This Section If Using .A.Builder T, 2f'PJ r>A IPK--4LS , as Owner of the subject property hereby.authorizz �� ,•f f LH i "") ' ne,��rt:-S t�o�act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) S V attire of Owner ate ✓6 e. 1 007 Print Name If.PropejU Owner is,appI ing for permit please complete the Homeowners License Exemption Form. on the reverse -s"ide.. Town of Barnstable oServices o. r 0 Regulatory Sez vices Thomas F. Geiler,Director • s.�xusr.�.st-e. . Building Division ibsp. . .$ PrEO '�k Tom Perry,Building Commissioner 200 Maid-Strcc� Hyannis,hfA 026.01 Rrxsv.to�rn.barnstable.ma.us Office: S08-962-4038 Fax: 509-790-6230 110TU,6%WER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street • village . "HOMPOWNER": name home phone# worlCpbonc# CURRENT MAfL1TIG ADDRESS: city/town statr rip 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,providcd that the owner acts as supervisor. DEFINMON 0F.H0MEWVXER Pergon(s)who owns a parcel of land on which he/she resides or intends to reside, on which thcree is, or is intended to' " be, a one or two-family dwelling, attached or detached structures accessory to such use m and/or far 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 Btulding 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) ility for compliance with the State Building Code and other The undersigned"homeowner"assumes responsib applicable codes, bylaws,rules and regulations. The undersigned `homeowner certifies that he/sbc understands the Town of Barnstable Building Dcpar incnt rrrinimum inspection procedures and requirements and that he/she will comply with said procedrsres and rcrgrrrircments. Signati.trc of Aomeowncr ; Approval of Building Official Note: Thrce-fan ly dwellings containing 35,000 cubic feet or larger will be required to cotnply with the State Building Code Section 127.0 Construction Control. v i. .HOMEOWNER'S EXEMYTION The Code states that; "Any homeowner perfotming work for which a building perrrrit is required shall be exempt from the provisions of this section(Section 1o9.1.1 -Licensing of construction Supervisors);providcd that if the homcov5mir engages a pa-son(s)far hire to do such wor% that such Homcowna shall act as supervisor." Many horncowncrs who use this exemption are unaware that they arc assurrring the responsibilities of a supervisor(sw Appendix Q, Rules&F-cgulations for Lieeruing Construction Supervisor:,Scction 2.15) This lack of awar rncss'oftcn results in serious problems,particularly when the homeowner hires unlicensed persons. In this ease,our Boar ar d cannot procccd against the unlicscd person as it would with a licensed Svpervisar. The homcowna acting es Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of hisAcr respannbilidcs,many communities require,as part of the po mit application, that the homeowner certify that hcIshe understands the respombilitics of a Supervisor. On the last page of this issue is a.form currently used by several towns. 'yournay cart.t amend and adopt such a form/ccrtification for user in your community. t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map / 7 Parcel ad z Application# Health Division 4f — ti Conservation Division �V O Permit# Tax Collector �At Date Issued Treasurer 2 Application Fee �O Planning Dept. Permit Fee 'tt SW r'7Q Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 117 4 sr A/k..... 5"r Village OwneraaerQ a ¢ �rh-z-g /I Address� Vcr Telephone 6ikij 50 ZO— f ��/674 VZ-74#—&9(0 Permit Request �1��/Y e+r �loA�//�i u" � el� OgKerapd,ilf � ft1's edd°f I"Y�f9C�4, Qd e lJtbktlgs / /_e44(9VV 181 100 1�'1 2yar(0'ar- b1PA'TWb1 .0A A YLl—'A wak 5'-do t� GLI) feau �Y.�eJ� Q P��c�e�Jc�et *�eC6N0_a/tW,, . Square feet: 1 st floor:existing c� 9 proposed n 2nd floor:existing proposed Total new 0 Zoning District Flood Plain Groundwater Overlay Project Valuation'! 7. Construction Type �OtivQ ur,� Lot Size 4 `Zo Q&fk a f Grandfathered: ❑Yes N'No If yes, attach supporting documentation. Dwelling Type: Single Family J4 Two Family ❑ Multi-Family(#units) Age of Existing Structure l >--/r Historic House: ❑Yes Jlo On Old King's Highway: ❑Yes kNo Basement Type: ❑ Full 'Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) -V .4 Basement Unfinished Area(sq.ft) �P�} Number of Baths: Full:existing 6L new Half:existing new C� Number of Bedrooms: existing c� new 0 Total Room Count(not including baths):existing new C5 First Floor Room Count -�6 / G'L w tfatc Heat Type and Fuel: CrGas ❑Oil ❑Electric ❑Other Central Air: )eYes 0 No Fireplaces: Existing 'a- New © Existing wood/coal stove: ❑Yes XNo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:,Wexisting ❑new size Shed:0 existing ❑new size Other: _ Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ <. i�j Commercial ❑Yes e26o If yes, site plan review# cry " o Current Use X- S c!/� d (eEPf ,` Proposed Use SA"i�- - �-- -- ec�UILDER INFORMATION Name 9. 1, COWAO« r.�sc�, Telephone Number O$-•�T _ ® �' Address 7 wp wt_n� e License#� 9� 1st4 c)IV J:1 d 61at;�a Home Improvement Contractor# /3/ 7-J 7 If Worker's Compensation#V 16C(0007 3000 1 zQ 0-5— ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY ' PERMIT NO. - DATE;SSUED MAP/PARCEL NO. ADDRESS VILLAGE . OWNER r� DATE OF INSPECTION: FOUNDATION r - S'�� Q1.2 f �ee� FRAME L KZ O /er e�6 v INSULATION FIREPL IJ'--��n' aA" ELECT M AL: ROUGH FINAL r PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL M f FINAL BUILDING,g� DATE CLOSED OUT ASSOCIATION PLAN NO. - Department ofbidUsh at Accidents ' Office of Investigations. ' 600 Washington Street Boston,MA OZIII. www.rnassgov/dia Workers' Compensation Insurance Affidavit; 13uilders/Contractors/Eiectricians/Plunnlbers Applicant Information PIease Print Le 'bl Name (Business/OrganizationandiAdual)• F Address: Sle '�SS'Q GG City/state/Zip: - !a IV f� Phone#• co, i Are you an employer? Check the•appropriate box:. L❑ ,I am a•employer with 4. I am a en T�gpe of projeet(required): g eral contractor and I ' employees (full'and/or part-time).* have hired the sub-comractbrs 6` ❑New construction ?.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7• [,Wemodeling ship and have no employees These sub-contractors have 8. [] Demolition worlang for me in any capacity, workers' comp,insurance. [No workers•' comp.insurance 5. ❑ We are a corporation and its g' Building addition required.] officers have exercised their 10•11 Electrical repairs or.additions f.❑ I am a homeowner doing all work right of exemption per MGL .11.❑Plumbing repass or additions myself.[No workers' comp, c 152, §1(4),and we have nq insurance required.]t employees.(No workers'' 12.❑ Roof repairs • comp.insurance required j 13.[] Other 4ny applicant fat checks box#1 must also fill out the section below showing their workers'compensation policy infoznoatioa ------------- Homeowners who submit this affidavit indicating they are doing a11'work and then hire outside eontraetars must submit a new affidavit iadicatin :ontractors that check this.bobs must attached an additional sheet showing the name of the sub-contractors and them.workers' 8 such• ." comp•Policy iaforXMlion. am an employer that is providing workers'compensation insurance for my employees'Below is the policy an dt'ob site formation. , isurance•Company Name: H SS®c.�a � • � alicy.#or Self-ins. Lia#:_ vie LCi,6©'7 ®�a t Zt90 Expiration Date• ab Site Address: 146S, M r S ti City/State/Zip: Ui • ,I / �S-- Mach acopy of the workers' compensation policy declaration a e •eaprat e showing the policy numbr and ii-on date). P .g ( . ) tilure to.secure coverage as requiredtrnder Section 25A QfMGL c. 152 can:lead to the imposition of 6jfininalpenaltzes of a ❑e up to$.1,500,00 and/or one-year imprisonment; as well as civil penalties is the form of a STOP'wORK ORDER and a fine Flip to$250.00 a day'against the violator. Be advised that a copy of this statement mare forwarded to the Office' ivestigations of the D1A for insurance coverage verification, of do hereby ce under t e pains and pen ''es of e ry that the in,�ormation provided above is t and correct E ttrre: /� � s��e 2- done#: Official use only. Do not write in this area,to be completed by city,or town official, City or Town: PermitUcense# Issuing Authority(circle.one): 1.Board of Health 2-,Building Department 3.City/Town Clerk 4. 6. Other ,Electrical Inspector 5.Plumbing Inspector Contact Person: Phone#• I� JAN-23-2006 10:44 64PAUL PETERS AGENCY 5085409641 P.01,01 CORD CERTIFICATE 4F LIABILITY INSURANCE - �F j '�ATE(tfffJ�qIttiY'tY) PRODUCER BIRDCP THIS CERTIFICATE IS ISSUED AS A MATTER Paul P®tars Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CER nFICATE � P 0 Box 669 HOLDER.THIS CERTIFICATE DOES NOT ARAFN0F FJfTE'ND'0R Falmouth MA 02541-0569 ALTER THE COVERAGE AFFORDED EY THE POLICIES EEd'.l:10r. Phone; 508-548-2500 7—`��m- --- INSURERS AFFORDING wsuREo - (a COVERdICiE PIAK,:.'- INSURER Nautilus Insuran e com --„-�— C F Bird Cnany, Inc INSURERe: AssoCiated indns Courtney Sir INSURER C' 433lmo PuPt W.%SSM Rd MAL 025540 INSURER D; .COVERAGES INSURERS: -„ —•••.�-- � THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING .- T ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY P@RTA1N,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCEI POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR NOR TYPE OF INSURANCE POLICY NUMBER _ GENERAL LIABILITY DATE MPN D MM1D _ — LJMIT6 A }[ COMMERCIALGENERALr1O BILITY NC333997 EACHOCCURRENCE� �� 04/23/05 04/23/06 1E-TPIEI '-'__ CLAMS MADE ('- CCUR PREMIe. ES(ER -- _ MED F,XP(Any ene Per.3 n; - PERSONAL 3 ADV INJURY'I$ Co 00g QI. �---�- M-- �GF.PI'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGR£(3ATE POLICY JEC- LOC PRODUCTS-COMP/OPACG AUTOMOBILE LIABILITY L ANY AUTO COMBINED SINGLE LIMIT ALL OWNED AUTOS (En orcluent) 3 I - i ; SCHEDULED AUTOS BODILY INJURY HIREDAUTOS (Perpersor.) NON•OWNEDAUTOS BODILY INJURY PROPERTY DAMAGE T� I GARAGE LIABILITY (Per accident) 8 ANY AUTO AUTO ONLY-EA ACCIDERrr r �- OTHER THAN! EA ACC 1 EXCESS/UMBRELLA LIABILITY AUTO ONLY AGO i.® - �— OCCUR CIAIMs MADE EACH OCCURRENCE g AGGREGATE --- DEDUCTIBLE �— -"`-- RETENTION S - --^- WORKERS COMPENSATION AND EIIEPLOYERS LIABILITYTO - TS ANYPROPRIE;TOR/PARTNER/EXECUTIVE VWC6007300012005 04/30/05 04/30/06 E.L.EACH ACCIDENT DEN& EJIoI S OFF(CER/MEMBGAEXCLUDED? __ 1 O aQ r(?(I(� II e.descROribe under E.L.DISEAS:�EAE7b1P � L s Erin:Ggo�nSlows oelow LOYEE S 1,DCw1 OTI9!Er- E.L.DIBEAsF•POLICY LIMIT r 0 vDt10 . D92CRIPMN OF OPERATIONS/LOCA ITONS/VJ;HICLES/E1(CLUSIONe ADDED BY ENDORSEMENT/SPECIAL PROVISIONB Building Contractor .'— CERTIFICATE HOLDER CANCELLATION ............ n,•-. TOWNPAZ SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED REFORc W49 Cl( IPATION F'OWtl at ry servile DATE?THEREOF,THE ISSUING INSURER WILL ENDLf4VOR TO MAIL 10 DAYS 4XI'TEN r.�:ly�u:atox�r Service _ H udldin.g Dept NOTICS TO THE CERTIFICATE HOLDER NAMED TO THE 46FT,BUT FAILURE TO Os.11 il;�AtL 200 Main Street IMPOSE NO08LIOATIONORLIABILITYOFANY rypuE rlTHE iNSURQ �;q�;�,I!11 ao. Hyannis MA 02601 REPReSewranvBS, AUTHORIZED REPRE89NTA %CORD 23 t2ft01lug) Joanna M. Jonas m A :D �l!Rd� ;Ttl aU'a�k1Ei$ RESIDENTTIA.L BUILDING PERMIT FEES 'PLICATION FEE - NewBualdings $10010.0 Resideatial Addition $50.00 Altemtions/Renovations $50.00 15-49..an Change of Contractor/Builder $25.00 , EE VALUE WORKSHEET EW LIVING SPACE square foot x$96/sq.foot= x.0041= phu$ombelow(if applicable) LTERATIONS/RENOYATIONS OF EXISTING SPACE square feetx Wfsq,foot A06 36 x.0041= plus$ombelow(if applicable). ?ARAGES'(attached&detached) square feet x$321sq.ft. x.0041= ' LCCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 . >750 3f- 1000 of 75.00 >1000 sf- 1500 of 100,00 >1500 sf-Same as newbuildingpezrmt: square feetx$96/sq,foot= x,0041= STAND ALONE PERMITS Open porch x$30,00= (number) Deck x$30.00= (number) Fireplaee/Chimney x$25.00 (number) , Inground S7imming Pool $66.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee THEri Town of Barnstable Regulatory Services * MARMABM y Mass. �, Thomas F.Geller,Director �A 0 a. TEn►r+�•+" Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done.by registered contractors,with certain exceptions,along with other. requirements. R. Type of Work: ! t 4 �� ® Estimated Costfi37 pOc7 Address of Work: 146r Atiq D 5 S Owner's Name: of Sk*n � �� Aer Date of Application: / Z I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ate ontractor Name Registration No. OR Date Owner's Name Q:fom1slomeaffidav i 84ARp QFx$kJ.l�;l]lNfa R9C�DLATIQN�$ Llcetas $TRU.CfiION SUPERVISOR �lllttt ( 030987 ate, �.— F 0 s i 06 Tr.no: 20140 COU.RTNEY:F 44K I FA THb Acting7CoVarnisigoner m ✓/ f� Board omrmco�:Rurealt/c ,,�✓l ndards 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' 131257 One Ashburton Place Rm 1301 ExplraSlQ0= 1/2006lug Boston,Ma.02108. a 1€ ' ype—e'"gte Corporation I 05 �.� C.F. BIRD 8 COMP INN ... COURTNEY BIRD t 43 SIPPEWISSETT ROAD,</,<,/ FALMOUTH,MA 02540 Administrator Not id wit�tout signature { j ° F-HUM HHUNb NU. r131 e21bUL30 Jan. :2i7 2011b 1,2:,51F'M f-:L ��► Town of Barnstable Regulatory Services Thomas F.Geiler,Director ' �I Building Division Tom Perry, Building Commissioner 200 Main Street, HyanWs,MA b2601 www.town.barnstable.ma.us 0-T-i.ce: 508-862-4038 Fax.: 5081490-6:230 Property Owner Must Complete and Sign Tl` s Section If Using ,A Budder YGL Yn� cB�' as Owner of the p r® ex� subject 1� f �' �' hereby authorise �f. rr DI YGL C,0 -�/� to act ori.n7 behalf„ :aa all matters relative to work authorized by this budding permit application for (,Address of Job) S#av=of Omer Date Print Name Q:F0FMS:0wNUF�?MWSS10X JAN-23-2006 16:25 From:ALMEIDA CARLSON FALM 5084577660 To:5085480617 P•11E CERTIFICATE (PANVDvtYVi T V TM, ERTIFICArI'E OF LIABILITY INSURANCE 091:321e,0A16 HopUCOR Rant..1$00, 0.8181 F-.: 808-I07.70e0 THIS CPRTIFICAT13 18 I88U9D AS A MATIOR OF INFORMA710111 A1.50910A,3 CARLSON INSURANCE AGENCY INC. ONLY AND CONFERS NO RIOWS UPON THE CERTIPBCATB P.C.%00K 064 HOLDER. THIS CCRTIPICATO D0E8 NOT AMEND, EXTEND OR FAI.MOUTH NIA 02041 INSURERS AFFORDING COVERAGE INSUREC INSURER A: Weetern World Insurance Cvmpi-n1v JOMN NEILL CUSTOM BUILDING&REMODELING INC INSURER a: AIO Insurance Company 101 BLACKSMITH SHOP RD INSURER Ci E FALMOUTH MA 0237I3 -- —w-•.- INSURtR Il COVERAGES'TR 'A°""„�""'•"� la OUCIUB OP INBUHA CR LIBTRE)SBLOW HAVU 13UEN iuwu6b TO THO IN8UNLID NAMUD AIilOV FOR THU 06QCYPCIM-D—lDl—CATQ0,07—A°f $TANDINO ANY RECUIREMQNT,TERM OR CONDITION OF ANY CONTRACT OR OTHSR DOCUMENT WITH RQSPQCT TO WHICH THIS CBRTIPICATU MAY nA IISUAO OR MAY PCRTAIN.THQ INSURANCQ APPORD60 OY THS POLICIBB 01:8CRIACD HERQIN 18 OUAJOCT TO ALL THU TERMS, QXCLUSIONB AND CCkIDITICINO OF SUCH POLICIOS.AOOROATQ LIMIT$ SHOWN MAY HAUL!BQQN RBDUCQD BY PAID CLAIMS AMdL Lyllwan TYPO OP INSURANCQ POLICY NUMBER POLICYIlInCnvf! POLICY exN8ATI0N LLMrr4 ~�rl: a6NORA6 LIAAIVIN NPP988860 04100103 04/08105 YAO OCCURIM.N2 $ `.�60 COMMCRCIA408NSRALLMAIUTY r"w-TORCHttl1.) $ •� PgllNlaf!�e Seas r�cpl CLAIM8 MA01311 OCCUR MUO UXP(Any oio pmon) —— A POASONAL8ASVKiwnY 1S _ 90R3flQ�l) _ aaNI11RAI,AGUROGArl IP R 1,rDi Er,C�ro1 aQNLAOQRQGATQ LIMIT APPLIU8PQR, PRODUCTB.COMP10i-lug 16� 1P16(I;QiI1D POLICY 0 PRO C• ..°..— nc,m,m,¢UI •o:[nrn, AUTOMI00144 LIABILITY ! COMAINQD BINCLQ LIMIT II1 ANY AUTO (Ea ecclaanl) ALL OW NED AUTOS BODILY INJURY .- OCHQDUUGO AUT08 (Par Rarmurt) in HIRED AUTO$ DODILYINJUAY — NON-OWNQD AUTOS (Pep Goldoni) PRORCRTY p.AWAOt T Par aect0t1l ♦mn�mn�„'urnw:YM OARAaB LIA8ILRY hy2c)9MLY �,AOCIDtINT _ ANY AUTO OTHER THAN AUTO ONLY: AGO S --- 6�� MCCIMBIUMBRBL.LALIABILITY CACHOCCURRONCQ OCCUR L__I CIAIM8 MADQ AQQRQGATlI D6DUCTIALG RQTENTION 6 g ,mtmm�onm,msun.r+nm WORKRR$COMPQNeATION ANQ WC0303409 06122105 08/22/08 T a i nim aT 1IMIPLOY9148'LIABILITY -- B ANY PROPIUMUNPARtN ROCCUTMB BA,OACH AC•CIOQNT ri_ �'14 ID�0610 OppIC9A>N loin e%GLUPBpT Q L DISIRA864A QP, OYpfi 11 91'O,iIIlO I1 dnaribs imdu 6/BGIAI.PNnvlero///rlow - ELL 010QA40-POWCYLIMIT 4. AI�0,0dip OTHER; DESCRIPTION OF OPERATIONSILOCATION8NEHICLESIf:XCUUBIONS ADDED BY ENDORSEMENT/SPECIAL PttcmaloNB I - +•s.o„•IY ®n'a®3Tmno®fnmP.mMpN G R'TII=ICIATE HOLDER CANCELLATION SHOULD ANY OF THQ AAOVQ DIaSCRIKO POLIC.'aA AID CANCfmLI.Ef:onFORC{'n< QXPIRATION DATA THBRBOP,THU MBUINO INSURER WILL 0NDSAVOR TO MAIL 10 M.AV# WRI TON NOTICtl TO THQ CQRTIPICATS HOLOrtR NAM[1f TO THf£WRT.BUT FAILI,iR!TD TOWN OF BARNBTAM 00 SO SMALL IMPOOU NO OBLIGATION OR LIADILITY OF ANY KIND UPON THIl INAUREN,Ill AOPNTB OR RCPRrBdNTATIVQS, AUTMONIYSD RQPRLMUNTATNU Aftentlon; Eji '1 1�1ta o �,r11 - _ m®art>•.nasRrt+.a..�.,,rnn¢umt.mn maune,„�M•Q uo• r A� CERTIFICATE OF LIABILITY INSURANCE - pg9QU 0� DATE(nTlnr pU/t VYYI i/2_:,/06 United _insurapce Agency, MI8 CE TIFICATE lS IS$U30ASA k1ATTEROF 11��U IVIIATIDI)l 199 1'lairi Street g '' Inc.Tnc ONLYAND CONFERS NO IZIGpi7S UPOIdTF�ECEI�{IF1CA1'E HOLDER THIS CBRTIFfCATEDOE33NC AfY1HllEa,EXTryt1I309 P.O. Box 1013 ALTER THE COVERAGE A-- BY E Buzzards Bay, MA ^�!�• Y MA 02532 -(-- --- 1NSUR® -- INSURERS AFFORDING COV�tAO INSURER A: CQmmeTCQ Ins. Co I-IAI�:�I_ -- Paul Smith - 92 Tanglewood Drive. INSURER B: Granite State any;, _ - k'ast Falmouth, MA 02536 INSURERC: —__• __ --- INSVRER 0 ^- COVE RA13M THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED ANY REQUIREMENT,TERM OR CONDITION OF ANY TOTHER O THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA iE1..Idd�T4VI'tiSiA t171NQ MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS WITH RESPECT TO WHICH c POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE SI EN REDUCED BY PAID CLAIMS, 71i1. CERTIFICATE MAY BE I$SLIED OR HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF J(;I- POLICYNUMBER POUC1 FEC71W LJCYB(PIRATDN OSNERAL LUO21TY --- A COMM QRCIALGENERAL LIABILITY HTQ983 EACH OCCURRENCE f 0013.a 0012/22/05 12/22/06 PREMI6� E , CLANS MaoE OCCUR ce) —0( - 1-- - MEUEXPRryom;.orson��-{iS--_ s„()0(J. PERSONAL$,ADVIW,IURy g _ GENERAL AGGREGATE S a —` GEN'L AGGREGATE LIMIT APPLIES PER: r_C}a 0 I POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2 . AUTONOBILELUBILITY ".ANYAVTO COMBINED SINGLE LIMIT ALL OwNEO AUTOS (Ea WZI-dwo SCHEDULED AUTOS BOUILY INJURY _ — HIRED AUTO$ (Per Peraw) NON-OWNED AUTOS BODILY N,JURY (P&,11cciPROd�rn (Par�d�p AM17AGE — i�.�._.—..._.__. 1 tiroAR,AGELIA6ILITY —�:•,.__�,--.�._.._.__.�Y ANY AUTO. AU TO ONLY-EA- ACCID2N.r S I OTHER THAN EA — AUTO ONLY; -- --- EltCeggrUMBREL_ALIABILITY A'u'G g FpCH OCCURRENCE OCCUR CLANS MADE AGGREGATE G DEDUCTIBLE —_._._ - ..__.._ U -_ — RETENTION $ WORK ER S COM PENSAT ION AN D 3 EMIL&MRS'LIABILITY '�' 12/24�05 12/24/06 RYLA V 0 -- ANY PROFnIMBRIPAR EXCLUDRIEXECUTPE E.LEACHACCIDENT E 100,0)() UL OFFICER/MEMBEREXCLUDED? �e E.L.DISEASE-£A EMPLOYEE.I$ 5()(1,0)o If , AL PROVISIt $below X OTHER E.LDISE4SE-FOLICYUMIT .I s 10CI,01)® 31CRIPTION+;IPq:I£IIATION£/LOCA710N$tVGHL-LESIGXCLUStON$AbbooBY END CRSEM ENT/SPECIAL PROVISIONS "----� ->•-- 'aintiI g .ttn: CourtnQV Bird - Fax no. (508)548-0617 9RTIFICATE FBOLDFR CANCELLATION SHOULD ANY OF THE ABOVE DFWRIED POL1C1E56E CMICr;IJ"5EFOREl'HR M(I-'IR,JTION DATE THEREOF,THE ISSUING INSURER WeLLENDIIAVOR.T�AMAIL 10 DPIIINILki•i-EN Town BDoa.@ NOTICETOECERTMICATEHOLDER NAMED TOTHELEFT,BUT Fd19..UFETODOSCI&!ALL Building Division TH 200 Main Street IMPOSIENO OBUQATION OR LIABf1UTYOF ANY KIND UPON TWRINIURER,ITS AgEffffl OR Hyannis, Ma 02601 REPIt TAIIVE$. NIT Eb A V — — ;al�n 25(2001/08) 0 ACORD CORPORATION 1938 '� Table JS=b(cannoned) psssctlpfi►e paekxgea for dna and' we4andly Raidential RvAdhW gated tjib Fouts Pods • MJl7Lf t1iLTt6! MttYttMlxTh3 tilizlag GUZWg Cel3ing Wall Floor Buctmeat •dpmcdl9mcle1 Amj ON U valdo &valuer R nlua� Ii,i�aiues Wa11 Pai�aeter �P�� +d�� ' A:yalue� R vsinet Fame ' 3701 to 6300 Se�tio D Da 11'f. 0.+h0 31 13 19 Id 6 Norasal R. 12'!. Ojt 30 ' "19 19 10 6 i�ormal • 13 '19 10 d. t3-AfUE g l2fi' 0.34 NIA 3E 13 , 35 NIA - -- - i 311 19 19 •30 y.: •' ,. +.,•13'y. 4.4#: 33 13 _ 23 NIA CIA as:AF1T$ �► lS'f. O.iZ 34 19' 19 10. d =?AFLJ R 18�1 033 ' 3E •'13" 21 NIA NIA y 1B'/r 0.41- 3E 19" 33 NIA NIA NOM21 Z ,• •18y. 0,42 '31 13 I9 10 6 90 AFVE AA 18'/. 0.30 30 19 19 t0 6 90 ARM 1.-ADDRESS OF PROPERTY; Z SQUARE FQOTAGE 3, S QUARE FOOTAGE OF ALL'aLAZ1NG•: . . ' 4 %OLAMNO AREA(#3 DNIDED BY#2): 5. SF,L,CT PACKAQE(Q--AA-see chtrt above); , vd��p Kc'�e r, A//)repT0 .5 Allove I ul-D 4u, 1� L � 2 ©raRMOn WVOLYED TFiODS OF DETERMININC3 BNBRCtY REQLI TS ARE AVAILABLE, ASK US FOR THIS WORMATION,. . C3 ° y to BUMI)ING INSPECTOR APPROYAL: YES'. gdcctns-198G303a 780 CMR•APPcudlx J , lass 'doors, skylights, and Footnotes to Table J .2.1b: assemblies (including sliding g Glazing area is the ratio of the area of the glazing• g opaque doors •to the grass wail a a'Of the total glazing area may be excluded from the U-value��ea uirement. Basement windows if Iodated in Wails that Enclose conditioned space,but excludin op qu Vaz,expressed as a percentage.Up t atn le,3 f�of decorative glass may be CXCIud ed o and documented the Manufacturer in accordance With For to P 1999, gia�8 U-ve�e5 must batested =After 3anuary 1, Council (NFRG� test Procedure, or taken from Table JL.S.3A. U-values are for• , . the Rational Fenestratica Rating • whole units: center-of-glass U=values cannot be used. If the insulation achieves the M1 ,fie Ce1g,R values do not assume a raised or ovErslzed {Hiss construction- be substituted for R 38 +M Exterior Walls•without compzt~sslon, R 30 insulation may'• o caul insulation thickness over the- ted'foR=49�lnsulatien: QeiliagR-Yal�ies�repr� trE-sum• ty� .�'.�R g •-- ay bi�1stilmi a laced between . 1 ulafion m insulatin sheatbia8 mud-4�,p -- insulatioA� used7•For ventilated t;eiliags, S hs�ioa plus nnsulatiag sheathing(if . , the conditioned space and the ventilated portion of the rod£ usE ?,Do not lacludo` ues resent the sum,of the wall cavity insulation plus insulating sheatlu. '( l ,. +Wall R-Ya1 .Fcr examgle,an R-19 rcqu izelmE conld'be met EITHER . • stcucti<ua1 sheathing,..and iutenor drywall. exterior siding, insulation OR R 13 cavity Insulation plus R 6 Insulating sheathing• Wail m��actionply'to by R 19 cavity to wall constructions,but do not apply to metal-from wood-frame or nisss(concrete,masonry: S) a r uirements apply to floors over uncondittdned spaces(such as unconditioned crawlspaces;>yasetaerits, The floor eq •requirements, , de must or garages).Floor Oyer outside air must meet the ceiling + entire opaque portion of any individual basement wall with an average depth less the idoorsc O f conditioned' The a ue poue requirement as above-grade walls. Windows and sliding 81• mmac the sam Basement doors must meet•the door,U-value requirement bns¢mpnts must be, included with the other gla�g• . w ' ed in Note b. an additional R.2 for heated slabs. d_scnb Bated slabs.Add tan to'install more . V.The p value requirements are for unh 'or 3..'If you P. es elet+tric resistance If use compliance approach 3, , 'tcllz i en the'equipment with the lowest + If the building u equipment or more than one piece of cooling equlpm t, . piece of heating q p. than One p efficient requizedby the selected package," .. Afric'iency must meet.or exceed the a closest city of town sea Table 15.2.1a spa Tits Mf NQ'�• - and•V-values are maximum acceptable levels,Insulation R values are mine acceptable-levels. a) Gleans areas R value requirements are for insulation only.and do not include structural components 035 Door U-values must be tested b�opaque doors in the building turar i envelope must have a V value no greater r Is not available,include the "anufaeturer in accordance with the NFRC test procedure orotaken from the door U Yalue ' and documented by them U-value rating for that do in Table 11.5.3b,if a door contains glass and an aggregate door •with vow windows and use the opaque door U•'vu ire t determine� �mPliance of the door. glass aTm of the requirement e* may Have a U-vat greater One door may be excluded from this req o trawl space wan component includes two or more areas with cj If a ce'rling�Ewa. tiaor,basem.Egt gall,slab-Edge, t ed averajo - greater than or equal to t insulation levels,the component compiles if the are components n#s comply 3f the a1C Elghted,average U- dlfferen , the R-Yalue requirement for that component.aisle °a U-Value requirement(0.35 for doors, value of all windows or doors is less than or equal , 43 . �CFrK�1u� �S Gxs Lt aC -� �p4 16. IX 9 � 16 X 19' _ IrtILtiY E s ------------- --------------------------- KITL O C L105 .. IE.4-iLL�RMIi 19��L _ �oa._ws 6ARA6E �NffASt W SU :i _ ..e,�.m.. ---- 0w..._._- ; 3yy Ora raoxr roaLH�• I--_fit__ -- _C ___� mer ^ OFi7: -O itf n - C` itYrXl- 1 �F I-R 5 T FL O O R P L A N - ' ix 5 Fa O J A101 swear+l eevaoor u M�•7 - 9 e - 3NDY - ' :18JGY1F� f t O m 3w WLU i x S E G O N D F L O O R P L A N - - - euac.v. .i•< OW W� �LL A102 � a MASTER BEDROOM BUILT-IN X NORTH AND SOUTH ELEVATION x MASTER BEDROOM BUILT-IN - EAST ELEVATION x MASTER BED BUILT-IN - I'��T ELEVATION OCT ROOM ss _ . N,swm�Ip. �U m ^ �W m(n e ELLJ X BATH # I - SOUTH ,n.)< x FIRST FLOOR BATH - KEST OZ LU> Z W J W A501 ----------------------- - nBATH I - NORTH BATH # I- EAST nBATH 31 I - SOUTH x BATH I WEST- - x .,- in.� i El IEUIEJ \ 0 � x BATH # 2 - WE5T BATH # 2 - NORTH y4..ilr.i e x BATH # 2 - EAST �.'e x BATH # 2 - SOUTH ' o UW m 3w m� Ws E _ s • x buest Bedroom - North x Guest Room - East G buest Bedroom - South �. b y KZ n OO WF zW r _ A502 PROJE C NAME: Ci►n�C� l wk�'�`'� ADDRESS: PERMIT# 01 Z- Li 1 2-U PERMIT DATE: LARGE ROLLED PLANS ARE rN: BOX iyZ SLOT -- Data entered it MAPS program on: BY: w TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION h Map �f"1 Parcel C3(2�- Ys°° Application #W� Q Health Division � 1 ^` fi Date Issued Conservation Division Application F Planning Dept. -,--Permit Fee Date Definitive Plan Approved by Planning Board `' Historic - OKH _ Preservation / Hyannis Project Street Address i S Vh./f G- ,1 CC) t z Village C Owner q-,;,A✓,, k:�o-eEKLi- 6 -Zt4'>_"N FIA19 ress '10 t2X0 0T_Lc_-FSL2� Telephone -7 7 4 " 5 Zt Z'�t - Z°3'"L - q V7 3 Permit Request J7;r-vA-o L_(s N`` --r> C-A4` u-t;Ey J4-,>- P42, + 9rce 1> Fi tz_ Fp c.4 C� �� 2�b.'c l Czg.;Mt,,CT b t4,r Q 5"v 2� q G2� a� \�G 2C 1-{ d `1 L e (YIP ]z c;L,C g t_q ��-,,-A-4,r>-,c D fi`P�P'�' Square feet: 1st floor: existing proposed 2t9v 2nd floor: existing ni��proposed ® Total new Zba Zoning District (Z Flood Plain t4 v Groundwater Overlay Project Valuation 0.to o Construction Type 0to� rAC Lot Size ll ."Lo Ac- Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ) Two Family ❑ Multi-Family(# units) Age of Existing Structure IS tm& Historic House: ❑Yes �Mo On Old King's Highway: ❑Yes X--�o Basement Type: ❑ Full -Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) D Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 2 new ( Half: existing I new Number of Bedrooms: existing D new Total Room Count (not including baths): existing V' new First Floor Room Count Heat Type and Fuel: 0 Gas ❑ Oil ❑ Electric ❑ Other Central Air: )AYes ❑ No Fireplaces: Existing ')- New ' Existing wood/coal stove: ❑Yes ONo Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION -- (BUILDER OR HOMEOWNER) Name it-j :wtc f_t—W'L ['f T -tAl L-717 rE2S o tAC. Telephone Number 570 "Z- k:;, Address Fa 7yX 4&o License # m Lf 0 00 024 3S Home Improvement Contractor# 1-51 09 - Worker's Compensation # G ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE kJqCZ6:71 DATE flod/�- 4 , l FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED ` MAP/PARCEL NO. ' ADDRESS VILLAGE ' OWNER f DATE OF INSPECTION: % FOUNDATION ly FRAME �' --►�lf�1r/ ��.3 iz �I*017-9"t I INSULATION '.w FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH - FINAL G, '. GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. . � Regurafory ServIC`es v . Tlxamas Y. Geiler,Director: g $uildin I ivfEion f Tomas Perry,-CB O,RaUdiag Com=u9monar m • 20o Main 5'Crr,�t, Hyannis,2�LA 02fi01 _ .�W.Eot�zi.bar-cu-taaIc.ata.us Officcc 508-862-�Q3 S Fax. 508-790-623.* PLAN . Owner G Map/Parcel: 0 / 7 ®O Z .Project Address i6eS..SIGI�-��v S1 �T BulderG The faIIc) g its were noted•ori z-ev�iewmg: 1 _ 4f PAS r1cKC-77oit/ ..0�. GOV 17 - ReYie*ad by: f Date: \ I ice UUMMUnrveuttn uJ lr1raNUcnuSeccs ZviDepartment oflndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ` 4 =� '` - www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Lejibly Name(Business/Organization/Individual): . �i`i� .� . W�e�UrC�A f`� e-t L ` _& t ssC . Address: , <�,6 ii6L-3';)o e -_J TLC City/State/Zip: V-!',7:5r. w=N- 07.V+P'bone.#: Sdr�-4'7-1 $S Co 7 Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4• ❑ I am a general contractor and I * have hired the subcontractors 6. ❑New construction . . employees(frill and/or part timel. . ' 2.❑ I am a•sole proprietor or partner- listed on the•attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have '8. Fj Demolition working for me in any capacity. employees and have workers' ' [No workers'comp.insurance comp.insurance. $ 9. Building addition required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all-wo officers have exercised their rk 11.❑Plumbing repairs or additions . myself. [No workers' comp. right of exemption per MGL . 12.0 Roof repairs c. 152 1(4), and we have no insurance required.]t � � § - , employees...[No workers' 13.� Other comp.insurance required] *Any applicant that checks box#1 must also fill out the section below.showing their workers'compensation policy information- t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new af5davit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my,employees Below is the policy and job site information Insurance Company Name: µ/fg i n(,5 c-i Z -.:LX_ Q4e ck4_r Policy#or Self-ins.Lic.#: 5c,R--t4 Expiration Date: f�'I 1 f Job Site Address: r y e—I 1 City/State/Zip: Q',J"_P Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a'firie of up to$250.00 a day against the violator. Be.advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct Simafore: C Date: f :. Phone#: -t 7 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): : .•k Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5..Plumbing Inspector 6. Other Contact PeFson: Phone#: . s "f z h a 4 U ° "� gDATE(MMID D ., /YY) AcornCERTIFICATE OF LIABILITY kN RANGE fiA r_ ,03/01/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,` subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER COMPANIES AFFORDING COVERAGE PAYCHEX INSURANCE AGENCY,INC. COMPANY GUARD INSURANCE GROUP 150 SAWGRASS DRIVE A ROCHESTER,NY 14620 COMPANY 877-266-6850 B INSURED STEVEN MCELHENY BUILDER INC c CPANY P.O.BOX 460 COTUIT,MA 02635 FOP- Y ;COVERAGES CERTIFICATE NUAABER REVlS10N 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. co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDDIYY) DATE(MMIDD/YY) GENERAL LIABIUTY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY 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 $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS ' NON-OWNED AUTOS BODILY INJURY $(Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACHACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKER'S COMPENSATION AND X wC STATU- OTH- EMPLOYERS'LIABILITY STWC350894 01/29/12 01/29/13 THE PROPRIETOR/ EL EACH ACCIDENT $ 100,000.00 PARTNERSIEXECUTNE INCL EL DISEASE-POLICY LIMIT $ 500,000.00 OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 100,000.00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddiUonal Remarks Schedule,If more apace Is required) CER`TIFICATE_HOL_k ' � f CANG,ELLATION TOWN OF SANDWICH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 16 JAN SEBASTIAN WAY DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY SANDWICH,MA 02563 PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVEat �. Office f�Conm'r'Affairs&rBus�ines� h License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ,,.157699 Type: Office of Consumer Affairs and Business Regulation ; Expiration: 101291,2013 Private Corporation 10 Park Plaza-Suite 5170 =_- Boston,MA 02116 S N MCELHE'NY BUILDERS?iNC -STEVEN MCELHENY , 1 r -1 56 BOWDOIN RD. ' MASHPEE, MA 02649 --"-" Undersecretary Not valid without signature• Massachusetts -Department of Public Safety Board of Building Regulations and,Standards I Construction Supervisor 1 &2 Family License: CSFA-047693 f �F_'rrs STEVEN P MCE HENY PO BOX 460 Cotuit MA g635 k A Expiration Commissioner 09/23/2013 6 _ A YYC Guirle to Wood Construction in High Wind Areas:1 10 tnph Wirrd Zone Massachusetts Checklist for Compliance (7so CN11R 5301:2.1.1)' - Check Compliance 1.1 SCOPE WindSpeed(3-sec. gust)..........................................::...................... ................:............................... 110 mph. WindExposure Category.................................................................. .............:...............................................B .r Wind Exposure Category................Engineering Required For Entire Project................................. .......0 1.2 APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) t stories <2 stories Roof Pitch ...............................:............................................(Fig 2 .........t t'L s.12:12 ✓ Mean Roof Height .......................g (Fig 2)................................................._ik ft 5'33' Vol Building Width,W ...............................................................(Fig 3)...................:............................ Soft <8o, ✓ BuildingLength, L ............................................................:.(Fig 3)............................................... 80' _ BuildingL/Aspect Ratio W Nominal Height of Tallest Opening2 .............................:.....(Fig 4)...................................................(,'-Ys 6'8' 1.3 FRAMING CONNECTIONS General compliance with framing connections:..........:........(Table 2)................................................................ 2.1 FOUNDATION - Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete...................................................:........................ ConcreteMasonry.......:........................................:................... ............................................................. 2.2 ANCHORAGE TO FOUNDATION1'3, 5/8"Anchor Bolts=imbedded or 5/8"Proprietary Mechanical Anchors as an altemabve in concrete only Bolt Spacing—general ........................................:.(Table 4)............................................. in. Bolt Spacing from endrjoint of plate................:............(Fig 5).................................... in.:5 6'—12 Bolt Embedment—concrete..............:..........................(Fig 5)..............................-- ................_in.>:7" Bolt Embedment—masonry........................................--(Fig 5).....:......:......................_...__... in._15" nL Plate Washer..:...........................................................:.(Fig 5)..............................................>3"x 3'x'/�" d S. 3.1 FLOORS Floor-framing member spans checked ........ ....:........... .......(per 780 CMR Chapter 55)........:.......................... Maximum Floor Opening Dimension...................................(Fig 6).............: ............................Lo ft<_12' ✓ Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)...............ry...................... Maximum Floor Joist Setbacks Supporting Loadbearing Wails or Shearwall... ........(Fig 7) .............................. .............�ft.<_d ✓ Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8)...............................................:....�ft <_d ✓ Floor Bracing at Endwalls..................................................:::(Fig 9)................................_..................:............... ✓ Floor She Type ........................................................(per 780 CMR Chapter 55)--.........:---.................... &LA Floor Sheathing Thickness .................................................(per 780 CMR Chapter 55)....................... in. "A Floor Sheathing Fastening..................................................(Table 2).._d nails at in edge/ in field t4A 4.1 WALLS Wall Height , Loadbearing walls..........::............................................(Fig 10 and Table 5)........_..................ID ft <10' ✓ Non-Loadbearing walls................................................(Fig 10 and Table 5)..........................._LP_ft's 20' ✓ Wall Stud Spacing ........................................................(Fig 10 and Table 5)..............t& in.s 24"o.c. i Wall Story Offsets . .........................................................(Figs 7&8)...................,........: ..........._aft s d ✓ 4.2 EXTERIOR.WALLS' Wood Studs Y q4vl � Loadbearing walls........................................................(Table 5)--........................._..2x -J iL ft in. Non-Loadbearing walls................................................(Table 5)...........---................2x .�.. {t_in. Gable End Wall.Bracing Full Height Endwall Studs............................................(Fig 10)..............:.......,........................................... _ WSP-Attic Floor Length................::..........:...................(Fig 11).....---..................................... ft z0/3 _o 'Gypsum Ceiling.Length(if WSP not used)....:...............(Fig 11)............................................_ft>t 0.9W _hL - and 2 x 4 Continuous Lateral Brace @ 6 ft. o.c... F'g 11 hh L or 1 x 3 ceiling furring strips @ 16"spacing min. 2 x 4 blocking @ 4 ft.spacing in end joist or truss b Double Top Plate Splice Length .................:.................................:....(Fig 13 and Table 6)....................................— ✓ ^-"-- ^-----`-- �-- -r aca .............. ....:�..1 (T�F.Ie�1 V ItL '✓ ATVC Guide to Wood Construction in H)�r11 14,711d Areas:_110 mph 1-Vind Zone Massachusetts Checklist for Compliance (7.s0 C)•1R 5301.2.1.1)t Loadbearing Wall Connections Lateral (no.of 16d common nails)................................(Tables 7)..................................................... I';- or Non-Loadbearing Wall Connections Lateral (no.of 16d common nails)................................(Table 8).................................._.................... 7- .� Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) HeaderSpans ............ ................................:......(Table 9)................................... ft 0 in.5 11, Sill Plate Spans ........................................................(Table 9).................................. ft o in.5 11' ✓. Full Height Studs (no. of studs)....................................(Table 9)..................... ......................... �- ✓ Non-Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) Header Spans.............................................................(Table 9)..........................._...... .r ft 0 in. <_ 12. r -Sill Plate Spans......................:....................................(fable 9)..................................�ft 0 in.5 12- Full Height Studs(no. of studs)....................................(Table 9).................._.................................:...—Z_[._ ✓ Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously,! Minimum Building Dimension,W Nominal Height of Tallest Openingz ............................................................................... 5 6`8' v Sheathing Type..............................................(note 4)......................... e zc .� Edge Nail Spacing.........................................(Table 10 or note 4 if less).......................... in. v^ Field Nail Spacing.............................. . .........(Table 10)................................................. in. ✓ Shear Connection (no. of 16d common nails)(Table 10)....................................................... Percent Full-Height Sheathing....................:... Table 10 ............... f 5%Additional Sheathing for Wall with Opening> 6V(Design Concepts).................... -.-� Maximum Building Dimension, L Nominal Height of Tallest Opening2......................................................................... 6'g. ✓ Sheathing Type..............................................(note 4)..................................................... zc t7tF Edge Nail Spacing.........................................(Table 11 or note 4 if less)........................in. v Field Nail Spacing.......................................:..(Table 11)................,................................ G in. ✓ Shear Connection (no, of 16d common nails)(Table 11)..............:........................................ 3 ✓ Percent Full-Height Sheathing.......................(Table 11)......................... Q% ✓ 5%Additional Sheathing for Wall with'Opening> 6'8'(Design Concepts)..................... Wall Cladding Rated for Wind Speed?................... 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool, see BBRS Website) (Figure 19 Roof Overhang ................................................... Fi ( g ) ............. ( ft<_smaller of 2'or V3 � Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift............. ... = If p ................................:..(fable 12)......................................... U Lateral.............................................(Table 12).............................................L i'l(v plf ✓ Shear..............................................(fable 12)............................................S= ptf• ✓ Ridge Strap Connections, if collar ties not used per page 21... (Table 13)...............................T=s If %40— Gable Rake Oudooker..........................................(Figure 20) .............I ft s smaller of 2' or L/2 g/ Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U=41-' lb. Lateral(no. of 16d common nails)...(fable 14)...................... -_L71(0 Roof Sheathing Type................:..................................(per 780 CMR Chapters 58 an Roof Sheathing Thickness.....................................:..... ............................................. ............�in. ?7/16"WSP Roof Sheathing Fastening............................................(Table 2)_.................. ... ✓.................... Notes: - 1. . This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of 780 CMR-5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are.not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. AlI Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a and Figure 18b 2. ' Exception:Opening heights of up fo 8 ft.shall be permitted when 5% is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure t eated#2-gr6de. AWC Guide to Wood Construction in High 1•Vind Areas: 110 nipli 1'Vind Zone J Massachusetts Checklist for Compliance (7s0 C11125301.2-1:1)' 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percei7t Full-Hdight Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16" and be installed as follows: L Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists, and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment 5. Glazing protection: a)new house or horizontal addition—required if project is 1 mile or closer to shore (generally,south_of Rte. 28 or north of Rte. 6) b)vertical addition-not required unless there is extensive renovation to the first floor c)replacement windows needs energy conservation compliance only(chap 93) 6. Wood Frame Construction Manual(WFCM)for 110 MPH, Exposure B may be obtained from the American Wood Council (AWC)website. WHEN THIS EDGE RMSON FF2AAIING USE8d NAXS • AT6"n.a I O 11 11 4 I - 1 1 !r I; A ' 1 � r l I r 0 ,i i il; , r 1 FRAMING MEMBERS 1 EDGE"rEF MEDLkTE I L l I I w i� 1) g , l. � ••.kk{{(1I is d u u �% Z rlklll • I, s 11 ,r yl 1 I 14 N r VJ NAC STAGGERED 3'MMJ NAILSPACM 1 NArL PATTERN PANEL PANEL PANF?EDGE DOUR-E NAIL EDGE SPAGNG DETAL See Detail on Next Page Vertical and Horizontal Nailing Detail for Panel Attachment Vertical and Horizontal Nailing for Panel Attachment OF THE THY Town of Barnstable Regulatory Services BAIINSrABIFy MAS&. Thomas F.Geiler,Director TEo 3�a Building Division` Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 6 12eJ A , as Owner of the subject property hereby authorize `f o-� �"``�� `� �u ��5 � to4Con my behalf, in all matters relative to work authorized by this building permit. (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Pant Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 Op7HE T Town of Barnstable P� Regulatory Services } * > xrvsrAsr E, Thomas F.Geiler,Director y MAss `bA iG39. •�� Building Division lFD MA'I A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION . Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner:engages a persons)forhire to do such work,that such Homeowner shall act as supervisor." ' Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt 1. ,TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map el 7 Parcel Application# Health Division {'`t —4 /3 QQ�)qNb Conservation Division Permit# Tax Collector Date Issued �� O "0& Treasurer Application Fee IV 44- 00 Planning Dept. Permit Fee' Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village � � Owner L J f'C� �.a--V J.e c 91 0-0 Address 4517` Telephone /� / Permit Request Svc c9.e;l a&4 Y'el ( o� �� l r' 1 Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ` 40)0,0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. r Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes J mo On Old King's Highway: ❑Yes ❑No Basement Type: Full Crawl ❑Walkout ❑Other, r Basement Finished Area(sq.ft.) ikJ A Basement Unfinished Area(sq.ft) A44 Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new t Total Room Count(not including baths):existing new First Floor Room Cout Heat Type and Fuel: XGas ❑Oil ❑Electric ❑Other �E ? Central Air: Yes ❑No Fireplaces: Existing New Existing wood/coal.Wtgve: ❑Yes ,�'No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑exis ing ❑new size Attached garage:Xexisting ❑new size Shed:❑existing ❑new size Other: "I Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Flo If yes,site plan review# Current Use__ w lc4 roposed Use_ 4 �� BUILDER INFORMATION Name Telephone Number Address S �� License# �� 7 Fe k4 �M EULS;r�6 Home Improvement Contractor# A3f Z5 Worker's Compensation# �' _ ALL CONSTRUCTION D BRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOr - �>.,1 SIGNATURE DATE FOR OFFICIAL USE ONLY .�., PERMIT NO. .h , DATE ISSUED MAP/PARCEL_NO. / r n , ADDRESS VILLAGE OWNER t DATE OF INSPECTION: _ FOUNDATION FRAME ® V/L-D6 XM41e- INSULATION Z 06 . FIREPLACE ELECTRICAL: ROUGH FINAL R PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING eo �b�ce�o /{ - r DATE CLOSED OUT ASSOCIATION PLAN NO. r ! N .... J ..�...,.................. Department of hidastizal Accidents ' r - Office of Investigations : 600 Washington Street Boston,MA 02111' www.mas&gov/dia Workers' Compensation Insurance Affidavi#: Builders/Contractors/Electricians/Plu a. >bers A, licant Information Please Print Le 'bl Name (Business/orpnization/Inaividual): e �L� �,,t ` fi Address: City/State/Zip: - /lR QZ.Sf 6 Phone Are you an employer? Check the-appropriate box.. Type of project(required):- 1.❑ 1 am a•employer with • . . 4. ER I am a general contractor and I employees (fhX and/or part-time).* have hired the sub-contractors 6• New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet.$ 7. (5j-Remodeling ship knd have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers'' comp.insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or.additions required.] officers have exercised their 3.❑ I am a homeowner doi4g all work, right of exemption per MGL 11.❑ Plumbing repairs_or additions myself.[No workers' comp. a 152,§1(4), and we have no 12.❑ Roof repairs •insurancerequired,]t employees.jNo workers'' 13.❑ Other comp.insurance required.] ' *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: \, t Homeowners who submitthis affidavit indicatiag they are doing all work and then hire outside cout actors must subadt a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp,policy information I am an employer that is providing workers compensation insurance for my employees.'Below is the policy and job site information. Insurance.Company Name: Policy#or Self-ins.Lie.#: /-,I Expiration Date• Job Site Address 1-4 S �foq•ov City/State/Zip: Dyi Attach a copy of the workers' compensation policy declaration page(showing the policy number and•ezpiratian date' Failure to.secure coverage as requiredYmder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$.1,500,00 and/or one-year imprisonment, as well as civ�penalties is 4ie form of a$TOP'WORK ORDER and afire of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce fy under the pains and peoes of e ' ry that the information provided above is i e and correct Sin' i atore: / s�cY�ate:. ! 8;( Phone#: O fficialonly. Do not write in this area,to be completed by city.or town offccial n: PermitlLacense# hority(circle.one): Health 2..Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: Information and Instructions h.f®r , ensation for their employees. Massachusetts General Laws chapter 152 teq ass�all employers in the servi euf anothePr under any contract of hire, pursuant to this sutute, an employee is define �Y P express or implied, oral or written." artpersip association,Farp or an two or more "a4 mdivi¢l A.,P oration or other legal entity, • y ,, An employer is defined aS;:. ''' to er,or the of the foregoing engaged in a joint enterprise, and inclining the legal representatives of a deceased emp y receiver or trustee of an individual,partnership, association or other legal entity,employing employees. Howcygr: _e ownpr of a dwelling house having not more than three apartments and who resides therein,or.the occupant of the dwelling house of another who employ$persons to do maintenance,construction or repair woil�bn such dwelling house or on the grounds or building appurtenant thereto shall not because of such employmentbe deemed to be an employer." agency shall withhold the issuance or Mr,xL chapter 152, §25 C(6)also states that"every state or local licensing renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any licaut who has not produced acceptable evidence-of compliance with the insurance coverage required." apt MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its,political subdivisions shall Additionally, enter into any contract for the performance of public wow until acceptable evidence of compliance with the insurance iegiirementsoft: schapterhave.beenpresentedtothecontractingauthority." • Applicants . . Please fin out ,the workers' coaPensation affidavit completely,by checking the boxes that apply to your situation and,if. sub-contractot(s)name(s),address(es)and phone numbers)along with their certifieate(s) of necessary,supply Ones(LLC)or Limited Liability Partnerships(L LP)with no employees other than the insurance. Limited Liability Come members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have to s o a policy is requited Be advised that this affidavit may be submitted to the Department of Industrial �P y tion re insurance coverage. Also be sure to sign and date the affidavit. The affidavit should Accidents for confirma be returned to the citY Or town that the application for the permit or license is being requested,not the Depari mcilt of e TitUr al Accidents• Should you have any questions regarding the law or•if you are required to obtain a workers' compensationpolicy,please call the Department at the number listed below, Self-insured companies should enter their self-insurance license number on the aFP7°Pnate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided regarding the applicant bottom of the affidavit for You to fill out in the event the Office of Investigations has Ylicant Please be sure'to fill in the perwiYlicense number which will be used as a refer ence number. In addition, an applicant- Please that must submit multiple permitlicense applications in any given year,need only submit one affidavit indicating current . (ifnecessary)and under"Job Site Address"*the applicant should write"all locations in (city or Pohl information +�A spy of the•affidavit that has been officially stamped or marked by the city or town may be provided to the #own)• applicant as proof that•a valid affidavit is•on file for;future permits•or'liceoses..Anew affidavit filled out year.Where a home owner or citizen is obtaaiing a li n is NO required to complete thise or permit not related to any eafidavits or tercial venture (ie.a dog license or permit to burn leaves etc.)said p • . Tye Office oflnvestigations would like to thank You in advance for your�gperation and should you have any questions, please do not hesitate tO give us a call. The Dep artmnf s address,telephone and.fax number:. The Commonwealth of Massachusetts . Department of Industrial Accidents .. • . . Office Q;f gt�veslagations r• 600-Washington S1reet� . Boston,MA 02111.• ' r `Tel.#617-727-4900 ext 406 or•1-,877 MASSAFE Fax#617-7271-7749 Revised 5-16111 www.mass.gov/ilia JAN-23-20OG 10:44 G4PAUL PETERS AGENCY 5085409641 ` P.0.1,,01 ooRD CERTIFICATE OF LIABILITY INSURANCE �� J eATE(nlLrinIMYry, PRODUCER b THIS C H Li LxI()b�l�.m,o P''#ot (V6 ONLY AND(CONFERS NO RIGHTS UPONHE CEBRTIPMATTER OF �I��3'9UJ!�I Paul Box 669 Agency, InC• HOLDER.THIS CERT9FICATE DOES NOT AMEN9Dr EXTEND III P O Pox 6 A ALTER THE COVERAGE AFFORDED BY Th91E POLICIE.c B9:d'(11mJ, ' Falmouth MA 02541-0669 Phon _ �`.--a_.1—_._�®� e 1 508-548-2500 ' INSURERS AFFORDING COVERAGE' wSUR� - INSURER A; _ Nautlius jn C F Bird Co INSURER e: Associated "''k Courtney mpany; Inc Indu&2:rims or 1�It13a 43 Si�_�_ 9o1B88t INSURERC- I TTi Falmou y IA 02 40d t ' INSURER D; -- - - — COVERAGESTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDINIm. ANY REOUIRFMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHFR DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED O;' MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITION4 OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LTR N8R TYPE OF INSURANCE POLICYNUMBER �PREMIOE=,S - D MMID �LILIITSGENERAL LIABILITY A X c CURRENC[OMMERCIALGENERALLIABILITY NC333997 04/23/05 04 23 CLAIMS MADE I�OCCUR / /06 u a-norm, 1� 1000910---- PAED EXP(Any`mp poraony I S 100(1 PERSONAL aADV INJURY- GENERAL AGGRE3,05 P-� GFrilAGGRE13ATE LIMIT APPLIES PER: --.._-_ r_ 5,00017;100 POLICY PR - LOC PRODUCTS-_COMPJOPAC,G - - — AUTOMOBILE LIABILITY ANY AUTO C COMMA EEntSINGLE LIMIT ( ) : ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) S HIRED AUTOS Y INJURY ---_ - ---_�-- _'.._�•�„— NON•OWNEDAUTOS BODILY(Parmo - G PROPERTY DAMAGE (PerePeident) 8 GARAGE LIABILITY — ANY AUTO AUTO ONLY-EA ACCIDEA!r S_ ._ — OTHERTHfSN EP,ACC -� — AUTO ONLY, EXCESS/UMBRELLA LIABILITY ..,,� aGG 3 EACH OCCURRENCE OCCUR CLAIMS MADE •'; aC3GRFG.AT_L '-- ,i1�—_. ..i-._—d I DEDUCTIBLE RETENTION $ •----�. -•-- ...,�__—. WORKERS COMPENSATION AND I _ aryl F S EMPLOYERS'LIABILITY TGR,L[dAITS I CH i ANYPROPRIETORIPARTNERrEXECUTIVE ---_- VVPC6007300012005 04/30/05 04/30/06 E,L.EACHACCIDEN1 _ S1�0d10,;1ti(1,0 OFFICERIMEM13ER EXCLUDED? __ _ _ SPyEee.0 dascriAL'R a Under E.L DISEASi__EAEMPLOYEE 3;I,r OCa0,000 6 i SPECIAL-g017�lONS Gelav __ _ E,L.DISEA.5F-POL.ICYL11vl1T f DUCIBPTION OF OPERATION51 LOCATIONS/VEHICLES I E1(CLUSIONe ADDED BY ENDORSEMENT SPECIAL PROVISIONS Building COAtraotoS .-•. --_...`_m 3 t , CERTIFICATE HOLDER i CANCELLATION .-�_ - —,-• :m..�m TOWNBA1 SHOULD ANY OF THE ABOVE DESCRIBED`POLIC,IESBE CANCELLED PEFOFlIcTI'-IEI!14F`EPATION 'Pawn of Barnstable DATE THEREOF,THE ISSUING1.0 DAYI9 I;IdFPITEN Il.Elgulatory Service INSURER WILL ENDEAVOR TO MAIL s� IC Citi ding Dept NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE..I,FF1'SLIT{AILUF;E TO GO 4 SMALL 200 Main Street IMPOSE NO 02LIOATION OR LIABILITY OF ANY KIND UPON THE INSURER,nN A413,a1'11 OR, Hyannis MAL .02601 REPRESENTATIVES. =AUTHORIZEDEPRESENTA7ACCORD a:; M. Jonas �.n�' A V Copiplow-.TUayd 79EI8 TOTAL F 01( �oEVE,� Town of Barnstable Regulatory Services M AM Eg` Thomas F.Geiler,Director �A ibsq. ♦� jEo,,,o+p Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done.by registered contractors,with certain exceptions,along with other. requirements. Type of Work: !t t . Estimated Cost P37 Ovc� Address of Work: 14 6 Owner's Name: .zQur GUPa r?skt/7 �)(Zraz, Alert? oXy`Z/ Date of Application: / Z3 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT-OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: �;167,6 01<54 FY �ib k,,'. F)4 A YAP,di(& /3/ ate ontractor Name Registration No. OR Date Owner's Name Q:forms1omeaffidav ' �' - �✓e.�arii�o�ueal�c o�.,��urarrc/u,�e�iA ;� BOARD OF BUILDINGREG�LATION;a I1 License(CONSTRUCTION SUPERVISOR N4m6 030987 :; 0 T 06 Tr.no: '20140 COURTNEY F B t 43.SIPREWISSETk F'ALMOUTH AcUntCc i oner Board ofuild»i g Reg�ulatiods an StandaKrfOds �fi 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: 131257 One Ashburton Place Rm 1301 ExpiraQ_ 1/2006 Boston,Ma.02108 lug hype—P ,gte Corporation -� `( C.F.BIRD&COMPAN „INI COURTNEY BIREQ 43 SIPPEWISSETT ROAD,� / FALMOUTH,MA 02540 '`._�='l Administrator Not id without signature i I FHUM F'HUNE NU. (81 e21bld-lW Jan. 20 �'_00b 1.�2:'AFM F1 C Town of Barnstable 1 SI 1 Regulatory Services Thomas F.Ceder,Director Building Division' Tom Perry, Building Commissioner 200 Main.Street, Hymmis,MA 02601 www.town.barnstable.ma.us t i CTlffice: 508-862-4038 fix Si�fl 7s)Sl E,:736)` , Property Owner Must , Complete and Sign This Section t If Using .A Builder { i �YGL r/l6?Jto 2—' ,as Owner of the subject property hereby authorize � to act on i7�belaaH4 im all matters rektive to work authorized by this building permit application for (Address of job) - 2/ o 5ignat=of Omer Date y Print Name Q.F1O S:owxBFP ssroN ; JAN-23-2006 16:25 From:ALMEIDA CARLSON FALM 5084577660 To:5085480617 OA i E(Dn INppIYYYY) A CORD TM, CERTIFICATE OF LIABILITY INSURANCE ) 41rt�1�aod1 . mn,ma■s.,..nu,una,mum,.•mv.n■ao µODUCUR Phonc batj, O•BiB1 Pax: 608-407•700 THIS CERTIFICATE 18 ISSUED AS A MATTER OV IN!FORII101014 ALM110A&CARLSON INSURANCE AOFNCY INC. ONLY AND CONF608 NO RIGHTS UPON THE MFITIFaCATEi p.r,,BOX 564 NOLDOL THIS CERTIFICATE D0E8 NOT AMEND, EXTEND OR . Fk.MCt"%IA 02841 & INSURE AFFORDING COVERAGE NAIL P R8 tN3UREq INSURER A: Western World insurano®C+amp�r�y JOHN NEILL CUSTOM SUILDINO&REMODELING INC INSURER er. AIG Insurenos Compsnj -^ 101 BLACKSMITH SHOP RD INSURER C B FALMOUTH MA 02875 INSURER C: --.—..._,.. COVERAOfrB .m■,. '■., TFb OUCI4B CP IN6UHA CE LIETED f3ULOW HAVa 04EN IBUU0 TO TKO INtlUNUD NAMGC Atl9V POR TH 0 CYPLR{OD 710 ICATQQ,'NG1TVVIr 5TAN1111,10 ANY RBOUIRUMONT,TERM OR CONDITION OF ANY CONTRACT OR OTHOR DOCUMIiNT WITH RQSPpCT TO WHICH THIS COR'I'IPICAT4f MAY fin 136LJOD OR MAY PCRTAIN.TH4 INSURANCE APPORDBD BY THE P0410105 01:8CRIPED HEROIN 10 AUBJQCT TO ALL TH4 TERMO, QxCLUB10NG AND CO:9nIT10NU OF SUCH POLICIAs•A®OREGATQ LIMITS SHOWN MAY HAVE RQCN RODUCQD BY PAID CLAIMS NSR LTiI �R POLICY NUMedR POLICYPPFACmd PoICY dXPIRATION LIM178 a ' TYPO OP INSURANCE - . adMiRAL LIABILITY NPRB8868 04108103 04108106 (m9m o-r-WIP0 C14C�_- -_— 6r��HI�•pal ,0t141 nAhNr�TO RcrtMO I< _ COMMCRCIA4 09NERAL LIABILITY ERaMIRI!e�ra CLAIMS MADE OCCUR M48 GXP(Any ane parcon) t A POROONAL&ASV INJURY mot...,- 1001);dIQO _ ©BNORAL#,0GRr4ATI1~u Y S,IID@FI,0011 a4N6AGGR4GATQ LIMIT APPLICOPQR, PRODUCTB.COMIDIOPA00 li e1,J@C1.fl011 ROLICv P C LDC �� o.e,.■,�o�.�: .c®:wumermn.m:.,,.:.. AUTOMOB146 LIABILITY COtAM=SINCLQ LIMIT 111 ANY AUTO (4q flcGlflenl) AL4 OWNED AUTOS BODILY INJURY T (PorRWW") ' 0CM11131.100AUTO® _�—.---_-._-• _I._..___.m.� .._ ....__, HIREDAVT06 BODILY INJURY `D h NON.OWNOD AUTOS (Per acalaalu) -- — — PROPCRTI'P:AMA0f1� d GARAW LIABILITY AUTO9NLY Mlm, 04orrvy.� ANY AUTO onieRTHAN _--- AUrO ONLY: A64 I; . Gan®�,,, mu,■m:.■in,w..v DICQRs/UUBRdLLA LIATJILITY OACH OCCU"nl`104 OCCUR _-I CLAIMS MADE A46R44AT4 L_ 06DUCTIELG - — --° -- R6TLNTION d a wORK9Ra GOMPgNSATION AND WCA909400 08f2Z14f3 Q8f22/08 _ T bnmm -11 EMPLOYCRS'LIABILITY @.L,EACH AVX1KNV 11 �� 11}Il_dIQQ B ANY PRCPR7GfolUPARrnaMD1000TRAI Q L,DI:4A C-PA CMT'40YOG li ' 91(S,(141Q W7rIC•JfUMntl00RCKGLUPEPT — � .__—....a,--.--...,.,...o.,. 11 yn dnodh■und■r ELL,,010QAOR-POLICY whiff d 61,0,011Q 6�dG)ALPRoveronfoProw �■:�+_ m:•n:•rm®m'^a"` ----------------- DESCRIPTION OF OPERATIONBI40CATiON6NEHICLESIEXCLUSIONS AbDED BY ENDORSEMENTI 8PVCIAL PIiCIvTn1 hRl$ S , CANCELLATION _ /:1:R'T11=1CA�TE HOLDER •a■.,.•n �•••� ."'"` "•�� SHOULD ANY OF THE ADOV4 OUSCRIDV..O POLIGIIj6 ON 4ANGEl1 L4 [iLiFC:R6 TI"I: EXPIRATION OATO THBRSOP,THQ I,RBUINO INitUF14R WILL.QNDOAVOR TO MAIL 10 0AV 5 WRn`TCN NOTICO TO THU agRTIFICATR HOLOGR NAMPO TO THI!LCIrT.BUT F1lt6`RC!TD TOWN OF EARNBTABI.E DO 60 SMALL IMP004 NO OBLIGATION OR LIAa1LITY OF ANe t(INP L)19014 T(i6 INOURCR,IT'S 1 AORNTO OR RQPRaSGNYATIV40. . s.,�ruaac.am=imar.+°r,m:rm.,o�a.�:.mvnv.c . AUTHOfQUO RaPRLBUNTATIVU for Attentions �■..� �m� ■,■..■,�.,�...m,...,,,■„m I AORD �ER"TIFICATE OF LIABILITY INSURANCE - DATE,n,m,aDryYYY, United ?n9ura�ce Agency, Inc, THIS COMFICATE IS ISSU (hE EDASA MATTER ORMATi5im ONLY AND CONFERS NO RICHM UPON RECERTIFICA"FE 199 Main street HOLDER THIS CERTIFICATE S NOT AIYIE END,EXTagQ OF,, P.O. Box 1013 ALTER THE COVERAGE AFFORDMBY THE I30I.ICIr!B l4 01y, Buzzards Bay, MA 02532 - ----- INSURF3i.S AFFORDING COVERAGE , INSURE "� ,. _ 10'EAI"0 IFA1meree Zns. C4. -Paul Smith 92 Tan lewood Driv® Ianitestatue]:Is IEast Falmouth, MA 02536 I I — —'— Covm rTms INSURER E gym.® ....... —) THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IPJDICAYEl7,Y B IdC?Tk11E ISSU@iD OF! �ES1ACsOING I ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MA MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM5,EXCLUSIONS A�JD C4NDIISSUE Or 8(JCh! f. POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, POUCYNUMBER POUCY FcCT1UE LICYB(PIRATpN —•:—__— —._ LI111TS GENERAL UASILITY EACH OCCLIRRF_N.C_r _�—a -�-1-a' 001 U0? I N7� rtE EMr $ 50 ()00A 3 COMMERCIAL GENERAL LIABILITY HT 983 12/22/05 12/22/06 x CLAMS MADE I•X�OCCUR MED EXP(A! c6iLFgxean $ 5,000 ••.— _..——_... PERSONAL&ADV UIJVRY. .i _ E,� 'EjO .(IOQ —' ---- — ---• GENERALAGGREQ�T'E S ) — I?d=F1'L AGGREGATE LIMIT APPLIES PER: r o PROnucrS-COW"10PAGG s _? 00Eb C100 �{ POLICY JECT LOC /IUTONOBILELIABILITY — ANYAUTO COMBINED SINGLE LIMIT (Ea a=idwo $ ALL OWNED AUTOS �--- - ------ ---- BODILY INJURY SCHEDULED AUTOS (Per person) 41REDAUTO$ -- BODILY INJURY NON-OWNED AUTOS (Pei"aWderro — — PROPERTY[)ay7AGE (Par eodderq ,g GMAGE LIABILITY AUTO 01JL'/_Ef,ACI;lUSvT- I g' ANY AUTO. -- OTMERTHAN I AA,C S — AUTO ONLY: AGG — EXCF_3S/UMBREL_A6IAVILITY EACH OCCVRRENCk' } — --- �J OCCUR CLAIMS MADE AGGREGATE -- 6� -- DEDUCTIBLE . RETENTION y — b WORKERS COMPENSATION AND IA`U-YE DTI' $ EMPLORS'LIABILITY T3A 12/24/05 12/24/06 TQEXLIMIT54 :M ANY PROW IETORIPARTNERIEXECUTI\E E.leACHHGCnDENT E 100,0170 OPFICER/MEMDEREXCLUDED? E.LDISEAS'.`--EAEMPLOYEE iA� 500,000 IT��aa desGll ba 181der X SPECIALPROVISCNSbalow E.L.DI$EAS:-FOLICY Lim r IE 100,QI)o OEM(:RIPTICN+;IFc)°ERATIONS/LOCA71ONS/VEHCLESI EXCLUSIONS ADDED BY END ORSEMENTI SPECIAL PROVISIONS Painting , s Attn: Courtney Bird - Fax no. (508)548-0617 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE 09SCRI BED POLICIEBBEQ06MCELLE IlIEFGnE1'H@11fl'IR,ATION DATE THEREOF,THE ISSUING INSURER WILL ENDF.AVORTOMAIL r �()—DAM11,1fR1T1EN Town of Baxnstable NOTICETO THE CERTIFICAtEHOLDERNAMrPT0THE.LEFT,BU1FA9LUfiIETODOSCI;3HALL Building Division IWOSENO OBLIGATION OR LIABILITY OF ANY KIND UMN THE iNIPirtER,ITS PaENTS".111 200 Main. Street REPR TATrSlES riyannis, Ma 02601 AuT Eb N ATV — ! I, 2'j ACORD 26(260 5X l.�A'C41RE)CORPORATION 19138 t , S I• v L r ol it - ?C tS r 4 rrvot S `r k. A d315 9Nu5Ix3 w ao /a3g �3 aSbW Mo-ms c �o O1 ❑ N3do ❑ u u u -SOn II SO1� II . II II A i Ukrov � Y _ a 000 j I .. L t -- - _.__�, i t �p � " �Q , \ V- ` � v V � I o � - �� o � f f ' .. ._. _. � - � ., ,.. ,y. ] L TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0/ 7- Parcel 60 Application# 40 O Health Division - Conservation Division c �� 5� Permit# Tax Collector Date Issued a� f Treasurer ® U" Application e i Planning Dept: Permit Fee! Date Definitive Plan Approved by Planning Board , Historic-OKH Preservation/Hyannis Project Street Address Village 1 t� Owner A U,O (/-)0/757&J*7 9G1604 1'P14 n ZAddress ,23 Telephone A Qf � e Permit Request /"Z- 44w " t �`!�/ N lu `? aox V-a Square feet: 1 st floor:existing proposed 2nd floor:existing proposed WL -Total new Zoning District*_8 O''D �kl Flood Plain A 1� C�� ,�' Groundwater Overlay Project Valuation nstruction Type DOp Lot Size �� `7s Q,c,f�< Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ;9' Two Family ❑ Multi-Family(#units) f Age of Existing Structure /d? Historic House: ❑Yes �Mo On Old King's Highway: ❑Yes .N"No Basement Type: ❑Full ❑Crawl ❑Walkout b40ther Basement Finished Area(sq.ft.) v Basement Unfinished Area(sq.ft) _ r Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new /ice Total Room Count(not including baths):existing (2al�&0-0_n ew First Floor Room Count C �xlS�r u s� H.eatType and Fuel: Gas ❑Oil ❑Electric ❑Other al Air: V Yes ❑No Fireplaces: Existing 2— New Existing wood/coal stove: ❑Yes �Mlo Detached garage existing ❑new size Pool:❑existing PX new size Zo e Barn:❑existing 0 new size Attached garage:4/existing ❑new. size he El existing V new size `x 9 Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Flo If yes, site plan review# Current Use ��s� �'�D Proposed Use BUILDER INFORMATION Name Telephone Number Address z1_ �s71,� �3 " fir '= - _License.# C'S 630 q9' 7 7d-- Ae�} gZS13�/o Home Improvement Contractor# j.6�7 } Worker's Compensation# Vu)L 6,00730©01ZO D,6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKENTO SIGNATURE DATE g L � r 1 FOR OFFICIAL USE ONLY s, PERMIT NO. DATE ISSUED _r MAP/PARCEL NO. ' �y ADDRESS VILLAGE 4 ` OWNER ' DATE OF INSPECTION: FOUNDATION OkA 6 p0 FRAME 9J1AA�s• , INSULATION , FIREPLACE ELECTRICAL: ROUGH FINAL , r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ao a q ,q Sc j e t DATE CLOSED OUT ASSOCIATION PLAN NO. " � `� ✓alie Uamromvozuiea� o�✓l�aaoac�ivael�.a . BOARD OF BUILDING REGULATIONS License:,.CONSTRUCTION SUPERVISOR Number CS 030987 Birthdafe ,04 40 Ezpiras 04E0612008� no: 21735 COURTNEY F BIRD JR 43 SIPPEWISSETT RR' Q � ::. G" FALMOUTH, MA 02540m Commissioner ,,,, �e �arrurnan,�srea,�� a�✓�/�wvac%uaelta �\ Board of BuildingRegulations and Standards Re g License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: R ion: 1312 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 6/21/2008 Boston,Ma.02108 Type: Private Corporation } C.F. BIRD&COMPANY, INC. f COURTNEY BIRD 43 SIPPEWISSETT ROAD ------ FALMOUTH, MA 02540 Deputy Administrator Not vali without signature 1 °FTHET°� ' Town of Barnstable ° Regulatory Services anxxaac.E Thomas F.Geiler,Director fo;9.�A�`� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-8624038 Fax: 508-790-6230 i Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. / j, j� Type of Work: (' l�l�e s1 ��! v- (Uer c az- Estimated Cost 5/7 Address of Work: 1��S /�it'eo1 Owner's Name: Q-v l <A?5Z�I/? —� � /'� ��l"'�2 4j,".le t?-- Date of Application: & I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereb apply for a permit as the a eut of the owner: arc Da a Contractor Name Registration No. OR Date Owner's Name Q formslomeaffldav... r` FROM PHONE NO. 7817216090 MaL1'. 01 ;'.00G (1,:;:kpl P 1 F r Town of Barnstable Regulatory Services Thomas B.Geller,Director Mr►er1. - # ��, its t � '` BuRding DfV on. =•' Tom Perry, Bond[ GbmmdssioaRt { 200 Main Stceat, JjY .MA(afsQl i f " ', al :k► i www.towo.barnstable4na ua F. Property Owner Must = { C=plcte and Sign This Section ( , Y t 5 1 :1 If Using A Builder it It 11 1 4 as Omer of the subject :»eFrrautharize to act on myPb igalf, +; �Pe � aPP , 1° '•� in an,;natters relative Towork authorized thus bu�ldxa rrrut lion for. �y + i + (Address 0110WA ` %�� ,, y}: ;•�R, d -sa e of Owner DUE Fick,Namr f t 7 it 13 4 ,q+ 1 ` ! • �.t. i d 7 {.i� i k L. The Commonwealth ofMassachusetts Department oflndustridAeeidents Office of Investigadons 600 Washington Street .Boston, MA 02111 www.masagov/dia• Workers' Compensation Insurance Affidavit: Builders/ContractorsXlectricians/Plumbers Applicant Information Please Print Legibly Name(Busiaess/organizadon/lndividu4', dA c-- Address• � City/State/Zip: dUi ��1� �?.�'g�a Phone#: `° Are you an employer? Check the-appropriate bog; Type of project-(required): 1,❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees (fall and/or part time)* have hired the sub-contractors e proprietor or partner- listed on flee attached sheet t �� ❑Remodeling 2.❑ I am a sale prop ship and have no employees These sub-contractors have st ❑ Demolition working for me in any capacity. kern' comp,insurance g, ❑ Buo7ding addition [No workers' Comp,insurance 5. We area corporation and its required.] officers have exercised their ME] Electricalrepaas or additions 3.❑ I am a homeowner doing all work right of exemption per MGL ME] Plumbing repairs or additions myself [No workers' comp. c. 152,§1(4),and we have no 12,❑ Roof repairs / /� insurance required.]t . employees.[No workers' 13.� O@>cr T®®l f-r,,1 0?C� comp.insurance required.] *Any appliceat that checks box#1 mast also fir]out the section below showing their workers'compensation policyinformatioa: ` t Amncownas who submit this affidavit indicating they era dying all work andthaa hire outside coatractars amst subm t anew affidavit indicating such ;Contractors that check this box must attachad an additional sheet showing the same ofthe sub-contractors sad their workers'comp,policy informstioa. ram an employer Mai is providing workers'compensation insurance for.my employees'. Below is the polky an4.iob siti Insurance Company Name; Policy#or 5ei".Lic. Vid c, (00m 7 30 06 2 0 p Job Site Address:— /6 S�� r �- r � City/5tatelZip': / A1*9. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date), Failure to secaro-coverage as required undet Section 25A of MGL c. 152 caii lead to the imposition of criminal penalties of a fine up to$1,500.90 and/or one-year imprisonment as well as civil penalties in the.foriu of a STOP WORK ORDER, and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce ",Under th ain and penult= pe ' that the information provided above is a and correc Sr foie: �% Date: Phone ci:di,AU • Do a h,,this afTe,to Ucompidoeff,b.Ct of ffj�,Iad I I City or Town: P ermfVL1 tense#• Iasuingg Authority.(circle one); 11.Board of Eealth 2.Building Depwtment 3.Ctty/—Iowa Clerk 4.Electrical Inspector 5.Plumbing Iaspector 16. Other ConitactPerson: Phone#: Informa' tion and Instructions Massachusetts General Laws chapter 152 requires all employers to provide vkTkers' compensatimfor-tbeir employees. pursuant to this statute, an employee is defined as"...every person in The service of another under any contract of hire, express or implied,.offal or written." "an individual, artners ' ,association, corporation dr other legal entity,or any two or more l er is defined as al,p . mp , I Air employer , p oin engaged in a joint enterprise, and'including the legal representatives of a deceased employer,or the . of the foregoing eng g J . o receives or trustee of an individual,partnership,association or offer legal entity, employing employees. H wevcr the . owner of a dwelling house having not moie than three apartments and who resides therein, or the occupant of the air work mt such dw&Uin house construction or r g dwellinghouse of another who employs persons to do maintenance, repair or on The grounds or building appurtenant thereto shall not because of such employment be deemed tob a an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing,agency shall withhold the issuance or renewal of a license or permit to operate a business or to contract buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance wlth the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states'Neifher lhe commonwealth nor any of its political subdivisions shall eater into any contract for the performance ofpublic work un-til acceptable evidence of comliance with the insurance requirements of this chapter have been presented to the contracting authority, Applicants Please fill out the workers'compensation affidavit completely,by chedemg the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the o ers' co sation insurance. if an LLC or LLF does have s or partners,are not r aired to carry w rk mpen member p eCi employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The•sffidavit should be returned to the city or.town that me application for the permit or license is being requested;not the Deparmoent of Industrial Accidents. Should you have any questions regarding the law or if you are required too obtain a workers' compensatimpolicy,please call the Department at the member listed below. Self-insured camp, 1-hodld meter their self insurance license number on-the appropriate line. City or Town OMdals Please be sure that the affidavit is complete and printed legibly: The Department has p rov'ded a space at the bottom. oft affidavit far you to fill outfn the eyert the Office of Investigations has to contict you regarding the applicant Please be sure to fill in The permittlicense number which wM be used as a reference somber. in additi n;am agpliraat thatrust subm mnttiple Permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job.Site Address"the applicant should write"an localions in (city or . " o the affidavit that has been off ' stamped or markedby the city or town may be provided to the town),"A f �y�P cops' the filled out each appheantas rfthat•a valid affidavit is on file far future permrts or licenses. Anew affidavit innsyearreme owner or citizen is obtaining a license or permit nptrelated to any business or commercial venture bum leaves etc. said person is NOT required to complete this affidavit. i.e. a do license or permit to ) p �i �p ( g P The Office of Imrestigations would lie to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax mnber: The Commonwealth of Massaaetts Department of Industrial.Accidents Office of 1RWftAfiW 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 os 1-577 YASSAFE ' Tax#617-727-7749 Revised 5-26-05 VNW.Mas s.cov/dia M*ZY--02-2.006 10:11 PAUL PETERS INS. FAL 5085409641 i?.0i)2 CERTIFICATE OF LIABILITY INSURANCE fI A PCi3° I'PTE 111@ ;)D1'YYY, ---� 131X q Fi IJ I/ i2/06 FaiODucEtF � � '.�"THIS CERTIFICATE IS ISSUED AS A MA'I"TF�,Fi'.OI�1A11"t;;LFl�t;711'1&:f;4 ONLY AND CONFERS NO RIGHTS UPQN THE CFRTIF K-.X E Paul Peters Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOTAIVIENC) i"XI E1JI I'054 . P 0 Box 669 ALTER THE COVERAGE AFFORDED BY THE PC)I.IUI�;'3 E3(,:L,(31 Palm lath MA02541-0669 ®� � _ Phone): 508-548-2500 _. INSURERS AFFORDING COVERAGE I,t ) r p,9�It+ I; INSURED - j — INSURERA: Nautilus YnsurarJ.o:e ER B _� I } •-- C F Bird Company; Inc INSU INSURERc Courtney Bird — 43 5ippewissett Rd INSURER D: Falmouth Mtn 02540 INSURER E. 1 g COVER E.331 � � �.� � o THE POLI(IEt OF INSURANCE-LISTED BELOW HAVE.BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.'NOTWITI,ISTANDiNO 1 + ( ' •a,�v ANY RE Z I R[MENT,TERIA OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR a-t POLICIES.GSRECA EULIMITFANS;OWN MAY HAVE BEENAFFORDED BYTHE IRIEDUCED BY PES AID CLAIMS EIN IS SUBJECT TO ALL THE TERMS,ExCLVS10NS AND CONDITIONS OF SIJCYI LTR SSE! _ TYPE OF INSURANCE POLICY NUMBFJt DATE M FEY DAT@ IRA . Y I t f l IIJt7 f B ,EFIERALIJABI'-ITY EACH OCCtI&2R yCl n ; 2('t)O( COMMCRCALGENhRALLIABILITY' NC$31712 04/23/06 04/23/07 PRATEiaMAIGStE TSr(rEru�RnT'� LC)0'lUU i CLAIMS MADE i•• U OCCUR MED CXP(f ny and Kagret•n)r .>: ' PERSONALE;AOfIIJJURY I �(11�t14'1i)1.1 GCNERAI.-AUGRI'_GATL f�Qf91,IQla;)(► CEIN'L AGGREGATE LIMIT APPLIES PFR; PRODUCT"-CONh10PgF( 3Qf)IIQu J(1 JECT f ' AUTOMOBII.ELIABILITY ANY AUTO a COMBINED_SINGI( LIMIT! •_ _ (ER 9CCldrnt) a }• k ( t a ALL OWNED AUTOS »_ a OODILY IMJl1HY -- CH[CULCD AUTOS (Per Pumon)- I''IR90 AUTOS — -- -- - _ NON-OWYED AUTOS r..#, (F'B�sGeidl�nit'!Y,` ..... . _ = PROPERLY IJAMA+ I: t' GARAGE LWBILITY I AUTO ONLY- ANYAV'f0 --' EA - - O'fHtRTHAN t, , _ ut �e AUTO ONLY: __. 19fC .SSIUIJIBRELLA LIABILITY - EACH OC(URRCN(1: a '.. _ I CCCUF. I CLAIMS MADE A=REGATE I{, DECUCTIBLC + of — f 11 rr ...J.RETCN•rION $ — �h ya. WOPo<LJi COAIPENSA'rION AND Wit.;iY}C(G J 9 EMP7.CtiEF'S'".IABILITI' TORY'LIIAII [ j 1-R I j• a s P ANYPFtOF4t1=YOfiriNRTNCR/EXECUTfVt t.L EAtIIAi LIDFNi. ( } OrTICJ:FWe'E4i,e;i EXCLUDCD9 H E_,.L.. DISEASE, E.—.CA L<eealx urdx SPVL PROVISIONS Mlay E.L.DISEf J — "l:•NOLIS%Y LI6',ff tG _: 1 ' OTHCA 1 ts s DESCRIPTKhf OF OPERATIONS!60CATIONS J VEMICLES!EXCLUSIONS ADDED 8Y ENDORSEMENT SPECIAL PROVISIONS Buildt_nq Contractor - The Worker's Compensation Certificate has been or&lxee1 ' s, ° Ij from the company and will follow under separate cover in accordance with t'lle,, ' Kass 146-1 ker Is Compensation Assigned Risk Plan ( 6,po CERIVIOKrE HOLDER CANCELLATION -�� TO'WNSA1 SHOULD ANY OF THE ABOVE DE$CPJOED POLICIES M.CIIN^;EL.6 1 Fi:Ba`THE E .AFIFATJQN - ,'r4wn Of Barnstable - DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR 1'1}�Mid— Regulatory Service NOTICE TO THE CERTIFICATE HOLDER NAMED TG PHF Lr FI;Bl l` I DII.t.M JcV PJ[Il .`C.MALL Building Dept 2 00 .Mairi Street IMPOSE NOOBLIOATION OR LIABILITY Or-ANY KIND UPON THP 11,18Ut'J ft I-r-,P N't:k OR r Hyannis MA 02601- REPRESENTATIVES. ' AUTHORIZED REPRESENT TIVE E_-- ; ' ,. +a a 7 t t: a "1 oil Joanne M. ACORD 25(2CQ1/Q8} I� �.(c>A!..OIaN. C.LF;F'(} .'11gz':)?I18138 {�: '+ux �"•: .:k 4 _ 1 ., , her F }...e•Z .,002 ' a ,{ I t *VAY. 2. 2006 • 4: 14PM ASSOCIATED INSURANCE NO, 4;!.�8_b_;.� 1115UR-DATE(MMiI?)rrt•) k � CE10IFICATE OF INSURANCE a--�••�•--- T1f8 CERTIFICATE mj&wED AS A MATTER OF IVTr'ORIiQA'�l';O?I O NLY A ND P:RODUC HIR CONFERS NO RIGHTS UPON TEE CERTMCATE AIOLI rP. T10 i C6,I TIHI(1 I Paul FElI1:1`i Agency Inc DOES NOT AMEMI,ErM-0 OR ALTER THE COVEHA,Gm AFHO IR1111I 119 EU 1b POLICIES BELOW. PO Box(569 /��{p �7��a�a N • ryrT 7[ + . � CV1Y1,C�1,�117%►7 AFFORDING�l..l.)Tf�1�141'l'�I Q� t! �_.�fl,�' La '�� •. Falmouth, MA 02541 INSURED C F Bird�c Co Inc EM?ER.Y A A.I.M. Mutual Insurance Co I ;` I 43 Sipromi^,set(Road +I - a , Falmouth, MA 02540 f i + ' ' t o Y TIIIS 1810 CER.TIFY THA'11 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAKED A130�+I FI)R 1 FIl I' 1 TC't t I r+'CoLi II4D:((.,\TEA NOTWITHSTF}LADING ANY REQUIREmENT,TLIRM OR CONDITION 012 ANY CONTRACT OR OTHER DOCUMENT'+1,R'I E P+sSI CERTIFICATE MAY DE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED RERUN'S SURJ13,.F f{) l'. EXCLUSIONS AND CONDrF10NS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BPEN REDUCED BY PAID CLAIMS --- POLICY EFFECTIVE POLICY EXPIRATIO +11 I CO POJ,ICY NIANDEB LA1ik7 9 ; I 'I'VPE OF INSkMAN(E nA7E(MMIDDIYY) DATE(MM/DDlYYI ti a _ - L GENERAL AOGRE('.ATL NERAL LLIDILII'X — I _. PRODUCTS COAJY+OP AG i. -� $ _ C;N'M:�P.CIAI,':IENERAt LIABILITY AI�1$MADE ; UR, PERSONAL A ADV;INHAN S EACH OCCURRENCE S 4 2pt:S do CONTRACT' R'S PRO'f - FILE DAMAGE(Any OW OM) MED.EXPENSE.(AoL-ax ,t � 4.._..._.._..,,v... AIr'UM+:B:�T.Wn13IX.ITV COMBINEDSIRGL6 a s` LIMIT --JN ED AUT0.S.L OWN i ODILY INJURY (I'd person)AUTOSIRED AUTOS ODILYINJURY(Persociden0ON.OWN£D AUTOSgRAGE LIABILITY PROPERTY DAMAGE EACH aCCURRF.NC6 XCW LIABILITY _ , � nGGREGATe __ _ -- • - JVMRELLA FORM OTHFR TITAN UMRRr>4LA PORM C STATU- Cfili- a WojtKEI'S(..!0SIMN.)ATION AND — ( - >IIa:Ir.Cr t Rs'1.+nBIUIY 04 3012007 k ---—.�._:—_._.._.... 6007300012006 04/3012006 A T}ItiPROIRiEI'ORI X INCL EL I.EASE.-PQIb1�Y LIMIC�._-___ _. __._s=...._,...n-" P/.F:INE:RS1EXc'CUTIVL _ P1.DIS6A F.-2AfiMl'L;VF.F .I -. •- 011FIC&S ARE: ) I D' i,tt ! fiSxRIP.rI(T W 0.YLIL+.TION3X,,OCAT10NWVLKICIE5/5Tr8P�1TE1vIS jj i i! CEIy f[EICA'CI.AOLDEA CANCELLATION _ .� SHOULD OF THE ABOVE DESCRIBED POI.,ICIIMS 1313 C,APIC I'I I :C IIF Iu I;E THIH I . EYPIRATION DATE THEREOF, THE ISSUINCn C:Oidfil4\IX ''A 11( 113tE1 k,LitF IF T 0 T�)�� e' SIPD•A TABLE MAIL 15 DAYS WRITTEN NOTICETOTI]ECEit3Lt�1(:,°.Ir:HCLDit ir,a1ti41 Da07:HS �rr1�• BUILDING DEPT. LEFC,BUT FAILURE TO MAIL SUCH NOTICE;;HAI�(;I6fP0513 �+} IF•1:IP„11 i�l'tr OR ' LTABILTTY OF ANY KIND UPON THE CO V(PA:.NY,t, I I, i e iFi N 1 S OR 20(I MAIN ST. REPRESENTATIVES. AUTHORIZED REPRESENTATIVE + iYANNIS, MA6601 i.... S r.. 5 ' G l i P 113 I I t OF oil 1 ' �+- ---______ I4 tl sr 1 4 P 1 L - - - = - - - - - - - - - - - - - - - - - -- --, lh� _ ---- w E z �r i _ w 3 coI' ;, rman s o - 1 1 l i Y tl!tl��itl �I I tl��i l tllii .eon rs _ 2 I 41. cr I Hill ----- i In If R O O F F R A M I . a F O U N D A T I O N P L A_N �1F I R S T F L O O R P L A NA- 0 " - y a A101 ff LZ N O R T H E t E V A T I O N �1 E A 5 T E L E V A T I O N - ....'.."' •'-° `,,�„,`;;,,�",,,; W ` N Z W 10 .. • , D 10 N O 00 .m a z o �15 O U T H E L E V A T I O N �\H E 5 T ELEVATI O N '• - -° A2O1 ----- - ---------- --- L-- - -------- --9mS�. -- -------- -- — i----- — ----------— A.::----- -. BVI LD I N0 SECTION A F Z W 0 U) Q' ¢a LU - s ------_ - --- IT --- ---- --------02 - rwsm auoe.re� -cwwiw" --------- — ------ eonwPwan-- N Z �B U I L D I N G S E G T I O N B — B O LU A301 TOWN OF BARNSTABLE v ICERTIFICATE. OF OCCUPANCY PARCEL ID 017 002 GEOPASE ID 444 ADDRESS 1665 MAIN STREET. (COTUIT) PHONE Cotuit ZIP - LOT 13 + 3B BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CT PERMIT 10994 DESCRIPTION SINGLE FAMILY'DWELLING PERMIT TYPE BCOO TITLE CERTIFICATE OF OCV6pdrfrV- ent of Health, Safety CONTRACTORS and Environmental Services ARCHITECTS:, TOTAL FEES: �tME BOND $.00 CONSTRUCTION COSTS $.00 • 753 MISC. NOT CODED ELSEWHERE t HARNSTABLE, ; MASS. 039. `0 OWNER HOLMGREN, JOHN K &c JE ADDRESS 45 MESSINA DRIVE BROCKTON MA BUILDIM: DIVISI:O DATE ISSUED 10/17/1995 EXPIRATION DATE BY Lr�' r i DIVISION APPROVALS FOR CERTIFICATE OF-OCCUPANCY TO BE SIGNED BY EACH DIVISION HEAD UPON COMPLETION BUILDING: DATE: } i COMMENTS"' PLUMBING: DATE: COMMENTS' ' . ELECTRICAL: DATE: COMMENTS: GAS: DATE: COMMENTS: CONSERVATION: DATE: COMMENTS: OKH: DATE: COMMENTS: HISTORIC: DATE: COMMENTS: FIRE DEPT.: DATE: COMMENTS: OTHER: DATE: COMMENTS: +1 - TURN THIS IN TO THE BUILDING COMMISSIONER.AFTER ALL SIGN-OFFS ARE COMPLETED.A CERTIFICATE OF OCCUPANCY WILL BE ISSUED AT THAT TIP�IE. .. TOWS OF BARNSTA13LE CERTIFICATE OF OCCUPANCY PARCEL ID 017 002 GROBASE .ID 444 ADDRESS . 1665 .MAIN STREET, (CQTUIT) MORE Cotuit ZIP LOT. 13 + 3B BLOCK LOT SIZE DBA DEIVELOPMENT DISTRICT CT PERMIT 10994 DESCRIPTION SINGLE FAMILY DWELLING PERMIT TYPE BCOO TITLE CERTIFICATE OF OCD*p:-ft F, ifientof Health, Safety CONTRACTORS: and Environmental Services ARCHITECTS: " TOTAL FEES �1ME BOND $,00 CONSTRUCTION' COSTS 1.00 753 MI SC� NOT CODED` ELSEWHERE # H�►RNSTABLE. +' MAS&. 1639. �0 OWNER HOLMGREN,. JOHN K J : ADDRESS 45 MESSINA DRIVE � BROCKTON MA BUILDMI DIVISION DATE ISSUED :1.0/'1:7/1995 EXPIRATION DATE BY .r 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 MAYBE 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 WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS 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 1 1 1 2 . 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL 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. 508-790-6227 BUILDING PERMIT i TOWN OF BARNSTABLE, MASSACHUSETTS BUILDING PERMIT rAF2117.002 November 1 B 94 Lt® ��9 i°a DATE 19 PERMIT NO. `4 a 2a Ic -►n t. tiol:igren APPLIC ADDRESS 49 auck'npliam T'12.V',, C04 LtzY - (NO.) (STREET) ' (CONTR'S LICENSE) _ . t� ISULL1J `;V_L'TL1u<_' % ��' ry TIT.; 1n NUMBER OF PERMIT TO L (_) STORY Jin1 ,.le Family �+ elli'•.Q DWELLING UNITS 1 (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) _ 1 = Cor_u`it . _A ZONING DISTRCT 7 (NO.) (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 CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: _T :T �4- AREA OR VOLUME )``' " i.. ESTIMATED COST :�`•�.t)�)l.1 a '_' PERMIT ; (CUBIC/SQUARE FEET) _ FEE .$ >)% OWNER !�:.ti:, - i7n1.-,..rpr BUILDING OEPT,. ADDRESS ,url j :;n, (,*a1, ^,•ri' BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED 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 THREE CALL .APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECALL CONISOTNRUCTQIONRED WORK:R CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS' ARE REQUIRED FOR ELECTRICAL, PLUMBING AND 1. 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 MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE.3. FINAL INSPECTION BEFORE - - OCCUPANCY. POST THIS CARD SO IT IS VISIBLE ,.FROM STREET _ BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS dczar- ,Art 9 izcs �Pc�2- Zs -SS - zV� ' t e C �I z I P R 1 N's/f z �� ) � �s _ ),pi Mdr� /`'ix l RA Lg/erA • �Q/� HEATING INSPErilOdlIPPROVIILS ENGINEERING DEPARTMENT P. t f el 9190�_� BOARD OF HEALT S. w/F , /0//�/, z=< _,zl, , & �b _")t L"HER SITE PLAN REVIEW APPROVAL ' E DEPT to 9T.. WORK SHALL NOT PROCEED UNTIL 1HE IP i- PERMIT WILL, BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS ND1CATr_LON THIS CARD CAN'8E TOR HAS APPROVED THE VARIODUS S-+ OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE' ARRANGED FCq gYTELL'HONE OR WRITTEN CONSTRUCTION ( P'iRMIT,IS.ISSUED AS NOTED ABOVE. NOTIFICATION The Town of Barnstable MAM • senrrernscE. • � Department of Health, Safety and Environmental Services ram" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344. Building Commissioner i October 21, 1994 Mr. Peter Curtin, Sr. Loan Officer Campello Co-Operative Bank 1090 Main Street Brockton, MA 02401 Re: 1665 Main Street (Lots 3B and 13), Cotuit, MA Dear Mr. Curtin: The above referenced lot is considered buildable from a zoning standpoint. In order for Mr. Holmgren to receive a building permit, he needs only to submit plans that conform to 780 CMR Section 2102. Sincerely, Ralph M. Crossen Building Commissioner RMC/km i Q941021C UF-61-20 -JOURHAL- DATE 10/21,'1994 TIME 15: 13 ccif-I DOC DURAT I ON /R IDE1,,JT I F I D. T I OH DYFE T I HE D I AGt-IOST I! 27 CC Ci oo:00 5r, Xl,,,IT T 94 26758 10/21 15: 1 :2 84044042 -Town of Blarnstable - 5 0,077 5 4 4- PANASOHI C- 4 V'� i� *J 4.;�J' - . • The Town of Barnstable • BARMABIA t MAMDepartment of Health, Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 I Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner f FAX TRANSMITTAL #of pages To: _{e-. IC�t4ok Fib i Co. ow 12 ogp. Oa S Ph"* 508)790-6227 f. Fax#�d�` '6 .S� Fax# (508)775-3344 i j i { i . . °� The Town of Barnstable snx�rsrns[�. ' Department of Health, Safety and Environmental Services 019.1" Building Division 367 Main Street,Hyannis MA 02601 j Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner i October 21, 1994 Mr. Peter Curtin, Sr. Loan Officer Campello Co-Operative Bank 1090 Main Street Brockton, MA 02401 Re: 1665 Main Street (Lots 3B and 13), Cotuit, MA Dear Mr. Curtin: The above referenced lot is considered buildable from a zoning standpoint. In order for Mr. Holmgren to receive a building permit, he needs only to submit plans that conform to 780 CMR Section 2102. Sincerely, Ralph M. Crossen Building Commissioner RMC/km Q941021C a--- --- - - - - - - �- 4 ,� � 1 I j ay�zrS,, :.� Y'+c �x i".,sue.. .r.S-� i..i� t`a��'�.,:.:�%, ��,s o?,7„N,x:- .. �;�•'�� ,� s�l� N TO i► .lJe V ��ATE SUBJECT c F's BY !�if P lops FORM 1232 �� } � LITHOINU.S.A. � r � J" _ 4 . W1,I1Q B ... ._• IB �B Y �B R c R .#m._:Q s -A - 1 I I 1 I ic a� � �_ - sN.rL.K•1es•o .K_ 16j 1 a -' bus• u iI r i - �b 7! LGV V6 ROOM N\5 ROOK - e' b'XIa• 6'x13' VS•.A ip I �i&I'I QP .c oc,rm —1— IN. FT, t s FATIO: i .es�.T. t __ •1 .. 'Y y .. GARAGE Y FAM5_X 3H...,� 1 .I �3 ;.. 1 .. - s J , rnm HA•o..,�s c,F_.Pere W M a..al 1N.1G.oLu rT yr s-T \\v/y LL OYES: K. - 1.THE 5.:.SHALL COORDINATE TVA WORK OF ALL T. ES QF' ITH THE ARCHITECTU2AL DRAWING$. NOTIFY THE ARCHITEC. .. - O OTHE GLLSHALL COOK 1I 7E THE WORK IGNOIGATEO ON THE LATEST LL ......._.. .__.._.. .—._...__. / RAMING AND ROOF TR15�PLANS WITH THE ARGHITEOTVRAL OSNJ_ REVISED F DRAWIN65. TNIS WORK INCLUDES ELT 15 NOT.LIMITED TO THE PLACEMENT OF COLUMN5,BEAMS.HEADERS,BEARINS FALL CONSTRUCTION,A.4P , ROOF—INS. V4•+I'-0' tlty/W PROPOSED FIRST FLOOR PLAN 3.ALL DIMENSIONS ARE SHOYW BASED ON FAGS OF FIN15H TO FADE OF on pp I wDp I FINISH,OR FACE OF EXTERIOR SND/FOUNDATION FALL TO FADE SLH AI! ,a _ OF FINISH WALL. - A.TYPICAL EXTERIOR WALL Cpf-TPoIGTION 15 TO BE AS FOLLOWS, �I,4GO4 f r : RID CEDAR SNIN&LES OVER RHNIII AP HOU5EH A`OVER..- -INNER SEAL OSB APA FkATED STRUCTLRIL 1 RATED SHEATHING Y ON 2X6 WO O STUDS•34.O.G.MAX. 5HEATMN6 A5 MP6R:'9 BY u' _ LOUSIANA PACIFIC OR APFFOVEO EWAL. INSULATE WALL KTI F T OWEN5 CORNfN6 H16H OENSITY Fb.SATT UNFAI EW INSULATION WITH A MINIMIM'R VALVE OF 21. INTERIOR FINISH TO BE VD-4 5eM5ONV- �. i V FIB6t RE-INFORCED 6YPSUH WALLBOARD OVER 6 MIL FOLT.VAPOR J BARRIER TAPE'ALL SEAMS IN HOU,&l P AND VAPOR BARRIER, .ry +,k;.i .+? f 43 - WITH COMPATIBLE PROp,OTS.5F`JJ_ALL PENETRiNTI016(OVfytT9, :. .. .3WTGHE9,.ETGI-MID PERihieTER OF CPEWN65 1N VAPOR'BMtRIPR. . ' t � y _°'•-a Imo• .. ...... _. - _ - I s; ,- e G i IR I a s r pI� t �, W � $ 9-7 el .. � BEDRGOM �__.1. 4.�c A , �.3' �-+A I��, _E _ _.-.T_.__ �♦.��`"_G5\\/ �b i I i � �I d �3 sia NF f•tj GL05. I� GLO�, \ �'IF "�1 - j -.. �. BATH �7111 'xla :OPEN TO B�LOw - —_J: \ XX —A RY=REBOx FLUE 4ND \r L HEARTH TO BE 51ZED IN CONF . LIN `� q:w•rn..wc-v.._T cv WITh FR ORTIONS A5 REGOFIMEN IeD I: I ` _ ♦ .1 K BY BIA'EC-NC?E5.0J1 ,tom I I I 1 en• � I �' .�IG STAIR OFE. op 4 F ^JfulK GJ_ST EEDROOM f ` e \\v f -BUN, PORGti \:_ � - � A -rt c�— — - A�• � I J� �. .. D I r— •. 1ltlp�'FI}II NO -V L � ~ J p, qA 01 ey .S H. PROPOSED SECOND FLOOR FLAN Cil \•. y J r� K"t—''�' rl i D€ IiIILEI r I L L Ir i! F L FiLJ r rx _ waSGo r I t ;. ti hill- Li i§: .' t. 9KAJ I S EY. R $ r — ----------- I --------- L-------�-� -� - --L--- ----------- --i PROPOSED EAR E�EVATiON N .= 7 CTA_ /\\�O^i5 TYFE K -- - -------.--- �'7 O`A_ W'NDOWS � n - DEL .i4 NC o ' 99-- yT Y' :"7 3':• .:6'E.V4 XD-51/l N �PF.fi _ ND / n I Y P°NJ fle33' i'-10 I/4%.S B/a 't•' r-.,'ltRIP'11te7 ;Y-ID!Je:%3 i I -n� `JI CR _-ANC-¢r - � - -.. _ —_ I �� I na p tV_ 3A3]- ]-IC e/e:X S S i/ N/' - 7<- ..•G' R' ! h-i� _— = ._ .. ... _. _._. � IM W • , _.tie :=lIi' I� I 11- II IJJ .W'zd7 } rt� dL. AW IO<a:ru a•�V l(6-31.2 WAG L.r,vo Tn 1 t r I -I I.�'I 1 _4�f(J VEQ R 'L W ANDEPSCh W 1:D�iWS \I i.-_I. /-J 4 �- I _ .�L. J-. _ 1 w Ui IL J` -:• ]D+�5Y1/ s!.lo/a xB':Ir W ,mcR-nv.AND-RIn - I o: Jl lw ,f' M'261p - VERIFY �-`::S':�jJJ6N -�594:'==.ue—.1•�v_aD%XX6-rE..�b��n TT-I�/t_/ra..—_o7L{_�WVYA5_AIPP JRER�RNGRRRGD I I FN�N—'66W/RR''A�PRPR'_.Co O Y.0 L IL NN./ W R O51ZE .`__.v✓.=_.\5_yr_<\_n.-N�r....R4a4. .-_ -il�J_t:-�--_'II-t--=�--_-J�.—'.'==J_ __.. . n __PvV -n Va Xui ERY Ro SIZyNANDOV WOW ;X 94 % NiD0x6 LL 3VAt RADIE O.51Za YOWS �F— . — --- s»IYera uc caDe-Bns-4TTeJ - _ _ _ 1/] X 1 A' 1 IaJ.- AP.D`/E CCOR,rNE"D' ---1 s x w 6,fia•, n��ii-05/e x9 o!n ML s'WOR AND TQ _ ELE V q'-O.' _.. .. w wo / xio'+ v�cPYRo5 EwANDE WmDcv ��'r 501L)TH ELEVATiO -- — — — — � I ' tLIR+Y v+tt+nopv r'EclracA CAI ——— — . — —— —' T O!J4.4�ID GF �. '� —jN - C. J . T+ T v ELEV.- Li — I I I I I r' 1 I P L �- I!• _- r �.. �. I.j 11 I I 1 I , .ELEV 25 b'i Iti 'ELEV 12-4.... I�©I Iz ——`——————— '`'+ec-PJtrn�'^Ec.u)+�ouR_w.i'a F. a✓r nREw eE'reEP�ra aF R _ ^ -----cva �eec�-- eP=swwne u°e°sFes.�w1"n rPe R'. .M1 _._I/ ✓V��T C._C JAT�✓� ----------- �...�.,-,ri.�scs..�—.ea-----_��War.n.n+r"iy�,o9ove rrrP� • � � --- x.o.00ce� .,ems � J Lu - / Tv F4T4 \__ELE .I E ✓-_ — I I I .. _ �' Z � s I ' pi p ti is o l W t .o•-j.o LK,.x f Yes .. A.I A'.. ips ., I - .,ELLV;:i •_ I '- i E EV_ ?-:. � I ' 1 I neaaaa �.c x+ I 6 16AR'AGE EAS ELEVATION I I GAR &E NORTH CLF\/AT'ION I I I SA cAC}E NEST ffLcVATIQN I _ R r y 03 �L 1� ED t , LOTS m 1 2 ACRES D s -C ' T � PLAN "Y a r LOCA TEp1� - 0TdI.I SY`�`�- t8'., L W 1L )'IC ytI ,y-L i �y = TONAL ^ Y 3 YY I /VQ::52792 yt� OF. PLAN sx4 DATE.:- MAY 27.41992= k r:. y� \ FILE No j658A K. 7AAWN :BY ..00S CHARLES 'DT38 2eoa5 r 'C�1p 6f IS.A/VDS�8NGINEERING �fC EP tis Sbil TE 2E �FAL7y0UT -ROAD MASS MASNPEE; H , I • 1 I i I I � . _ W ,. .. l µ v H LOTS 38 6 19 m 10 2 ACRES ,- PLAN m r / 4TE TUX �u/7_ kJ 1 t 1•'• r�'1 - y T` 1 .. tt�w� �� , - ..V� {!�� L•n�� 4 �`I .ale�° � �� i (/J� 1 s ,cv�y 4 � . .r � >'..`t..� :� ` z r�i �y J lr •a�y.-s 1 -f�'-.:.: i �llS`kiAS,��;,�,y= '- aF PL 7.0 r: , FILE N0;:165BA ��. � s=� ;DA oAvIo flRAWN'BY OCS F / CHARLE3.'. N :B NOD 38 r }t. 13 SANICKI f eoe5 rI. 'CAFE � S.AND � NGINEE'RING ; t33 FALMOUT ROAD - SLITE 2E �� r� � t• ,��, ; :MASNPEE. MASS :� ro , ; 41 62'41 Zoo.55 j sA. 17 tna � I s D.6 a 1 f w d y W I j 66rod -- !a` �- tnoj L o. goo paa' .t _ 1 n ' 1 D rL is �1 s As cssor'1.Office 1st floor Map W1 I Lot Permit#' ✓Conservation Office 4th floor Date Issued Beard of Health Ord floor 1� Engineering Dept. (Ord floor) House# Planning Dept. (1st floor/School Admin.Bldg.):- VAMUMMi Definitive Plan Approved by Planning Board 19 1039. (Applications processed 8:30-9:30 a.m.& 1:00-2:00 p.m.) ' TOWN OF BARNSTABLE Building Permit Application ?roiect Street Address �(o r��J � �� -� / %G� e fi r Villa —i'iC.�c% Fire District r-- Owner Address Telephone ��C� // Permit Request: 0'�—�C/ y'A Zoning District Flood Plain Water Protection Lot Size Grandfathered Zoningz Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Existing Information Dwelling Type: Single Family Two family Multi-family Age_of structure Basement type Historic House Finished Old Kind's Highway Unfinished Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other 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 O-WA) 44-•JSr?'96L� D /LC �/ /0 W O&� Ld4S- • Proieect Cost 4) per' Fee SIGNATURE DATE 4V BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T RACKAUSKAS, ROMAS FOR OFFICE USE ONLY cc , (ADDRESS 1665 MAIN STREET, COTUIT VILLAGE COTUIT OWNER ROMAS RACKAUSKAS DATE OF INSPECTION: FOUNDATION Y i ri 4 k INSULATION" FIREPLACE c "ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING: DATE CLOSED OUT: , ASSOCIATE PLAN NO. d FOLD AT ARROWS(• •)TO FIT WINDOW ENVELOPES Message=Reply CORAflectricTM El Urgent ❑ Please Respond By 2421 Cranberry Highway ❑ No reply Necessary Wareham, MA 02571 TO: _ Giedra A. Rackauskas Date: Sept. 28 , 1994 Subject: Message: The electric service and meter at 1665 Main St. , Cotuit FOLD FOLD ~ were removed on Sept.27 , 1994 . ~ Signed: Barbara Trocchi Customer Service Rep. Reply: MF46E OF �* 41COtuit ,f ire Diorkt . CO= . D 9 t926 Water Mepartment ° �� r JU 4300 FALMOUTH ROAD, P. 0. BOX 451 COTUIT, MASS. 02635 September 26, .1994 Office of the Building Inspector Town Hall 367 Main Street"J` Hyannis, Ma 02601 To Whom It May Concern: This letter confirms that the water service has been disconnected at 1665 Main Street, Cotuit, as requested by owner Giedra Rack- auskas. Sincerely, _ tit _ Leonard Mend.es Superintendent ,, Assessor's Office 1st floor Ma o Lot b O v G; Permit# . Conservation Office(4th floor) Date Issued Board of Health Ord floor) d Engineering Dept. i3rd floor H # "House Planning Dent. (1st floor/School Admin. Bidg.): i i aAmwr.A i MAFA Definitive Plan Approved by Planning Board 19 i (Applications processed 8 30-9.30 a m & 1'00-2.06p m) TOWN OF BARNSTABLE Building,Permit Application Pro'ect Street Address �(o J 177,�IAI- Village Fire District —2 `'— i Chvncr Address 7 u � Telephone ' r I �� W� j I er Permit Reauest: Zoning.District Flood Plain Water Protection Lot Size Grandfathered Zoning Board of Anneals Authorization Recorded Current Usc Proposed Use " Construction Tyne Existing Information Dwelling Tyner Single Family Two family Multi-family Age of structure Basement type Historic House _" -- Finished Old Kine's'Highwav Unfinished Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name Telephone number Address License# Home Improvement Contractor# Worker's ComMusation # NEW GGNSTRMTIQN OR APpITIQNS RF.QLJ E A SITE PLAN (AS BUILT) SHQWING EXISTING, AS WELL A$ PROPOSED STRUCTLUS ON M LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO `% l0 c z�r2 LdS Project Cqst Fee SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T f OAI Assessor's,Office 1st floor Ma A� t M2 Permit# . Conscry Lion O ice 4th floor - Date Issued �/ g Board of Health 3rd floor 'T-(p/ Main St: Cotuiit �u Engineering Dept. (3rd floor) House# 1665 Ma • Planning Dept. (1st floor/School Admin.Bid .): m. i ,��"�, t Definitive Plan Approved by Planning_Board °° l�� 19 q-7 �� +bsa (Applications processed 8:30-9:30 a.m.& 1:00-2:00 p.m.) TOWN OF BARNSTA Building Permit Application , Proiect Street Address 1665-Main St. ( �� 13 IB13) Village Cotuit Fire District Owncr John K. .lblmgreri Address 49 Buckingham Way, Cotuiit ` 426-0620 583-2595 Telephone ' Permit Request: l Zoning District /C Flood Plain A11 Water Protection Lot Size 1.2 Acres Grandfathered Zoning Board of Anneals Authorization Recorded Current Use Single Family Residence Proposed Use Same Construction Tyne Wood Frame Eaistine Information Dwelling Type: Single Fanuly Two family Multi-family Age of structure 'r Basement type Full Historic House Finished . Old King's Highway Unfinished X Number of Baths 3 No.of Bedrooms 5 Total Room Count(not including baths) First Floor Heat Type and Fuel Hotwater by oil Central Air Yes Fireplaces 2 Garage: Detached Other Detached Structures: Pool no Attached X Barn no None Sheds no Other n/a Builder Information Name Douglas A. King.BuiRders Telephone number 238-2038 Address 50 Oliver Street License# 017 017 N. Easton, MA 02356 Home Improvement Contractor# ----- - - ---- - - -- Worker's Compensation # !Vrl-312-497519-014 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. Off Calif S7ae3e ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO :: _- -= Wi 1 der St B,_kt. �, Proiect Cost 6V,/ Glob Fee / SIGNATURE _ DATE BUILDING PER DENIED FOR THE FOLLOWING REASON(S) X BPERM T 3 1 FOR OFFICE USE ONLY ADDRESS 1665 Main Street VILLAGECotuit a a OWNER John K. Holmgren , ti r DATE OF II ISPECTION: FOUNDATION ,151J5 FRAME INSULATION -- a } FIREPLACE `! ELECTRICAL: ROUGH FIN;AIL PLUMBING: } ROUGH FINAL _ GAS: ROUGH i -- FINAL . FINAL BUILDING: DATE CLOSED OUT: r ASSOCIATE PLAN NO. i COMMONWEALTH OF MASSACHUSETTS —E 7 DEI'ARTMET, IT OF IINTDUSTRIAL ACCIDENT'S 600 WASHINGTON STREET fames Gamaoen BOSTON, MAS,SACHUSETTS 02111 WORIERS' COMPENSATION INSURANCE AFFIDAVIT Doug A. King , of Douglas A. King Builders _ (licensee/permittcc) with a principal place of business/resadenee at: 50 Oliver St. N. Easton, MA. - 02356 (City/State/Zip) do hereby certify, under the pains and penalties.of perjury, that: Pq 1 am an employer providing the following workers' compensation eoveragc'for my employees working on this job. Liberty Mutual WC1-312-497519-014 Insurance Company Policy Number [ ) 1 am a sole proprietor and have no one working for me. j ) 1 am a sole proprietor, general contractor or homeowner{circle onc) and have hired ahe conrmaorslistcd bclow who have the following workers' compensation insurance policies: Dame of Contractor Insurance Company/Policy Number. Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number D 1 am a homeowner performing all the work myself. NOTE: Plcasc be aware tbat while borncowDen wbaemploy pccsons.to do mainunance,construction or repair work'on a dwelling of not more than tbrcc units in which the bomcowner also resides or on the grounds appurtenant tbereto arc not gcncrJ- ), considered to be employers undo the Workers' Compensation Act(GL C. 152,sect. 1(5)), application by a bomeowner for a 11ICCnse or permit may evidence the legal sutus of an employer undcttbe Workers'-Compensation Act. 1 understand that a copy of this statement wiU be forwarded to the Deputment of Industrial Accidents'Office of Insurance for.eovcrgc verification and that fzilurc to secure coverage as required under Scction 25A of MGL 152 can lead to the imposition of-vdminal penalties consisting of a fine of up to S1500.00 and/or imprisonment of up to onc year and civil penalties in the form of a Stop Work Ordcr and a f inc of S 100.00 s day against mt. t Signed t 's 1�2 day of 4C' TO �/� , 19 -z2 z�r� Licensee/Perm i e Liecnsor/PermitTor f ��oz v r F• TOWN OF BAR14STABL£ 13UlLDINGµ DEPARTMENT- HOMEOWNER LICENSE EXEMPTION Please print. DATE 10/17/94 1665 Main Street Cotuit, Massachusetts JOB LOCATION Number Street Address, SectionOf Town _ "HOMEOWNER" John K. ►3olmgren 508-5837366 508-583-2595 t Name j Home one Work Phone 1308 Belmont Street PRESENT MAILING ADDRESS i _ Brockton Massachusetts 024{31 City/Town 'State Zip• Code The .current exemption for "homeowners" was extended to include•.owner occupied dwellings of six units or less and to allow such 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 to six 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, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the-Town of Barnstable Building Department minimum inspection procedures and requirements HOFLEOWNERIS SIG14ATURE �S APPROVAL OF BUILDI14G OFFICI Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127 .0, Construction Control. xiscs .r _ j 110--M_O1}�JER'S E}iEifPTION The ca„ that : perMii i S Owner performin work equired shall be exempt from the g for which a . (Section 109.. 1. 1 - .-Licensing Provisions buildin< , •; Home Owner engages a person(s) Construct supervisors) this section Owner shall act as supervisor "for hire to do such -work provided that ii that'::s uch -Home Many .Home Owners who use this exemption are unaware the responsibilities of a supervisor (see A na . 'µ for Licensing pp dix that they are.:assumin awareness Oftenoresults -in serioussorob'1 Q' Rules :and `k g ,..Section 2. j This gulations -Owner hires i5` lack :of unlicensed ersons. problems, particularly when- .the P In this case our. Board cannot'rt'' 'rocRome against the unlicensed person as it would,with Home Owner acting as supervisor is ultimatel nc�eOsed supervisor.eed Y Supervisor. The .. To ensure that the Home Owner. is ful y aware many communities re uire of his%her responsibility., Owner certifyq �' as part of the pelt application, i On the last that he/she understands the,responsbilitiesof a' s page of this issue is a form currentl that 'the Home You may care to amend and adopt such a form uPervisor. community, y used by several towns. . : .. /certification for use` in your .. .. ' . . .. fir . Assessor's_Offiice 1st flooi Mab 7:: t & Permit# . Conscrvaton Office 4th floor Date Issued r Board of Health 3rd floo -(p/ c�riSJ 1665 Main to Cotuat � Engineering Dept. Ord floor) House# _ � Planning Dept. 1st floor/School Admin. Bldg.): Dcfinitive Plan Approved by Plaitning_Board v TIj�.; 19 (Applications processed 8:30-9:30 a.m.& 1:00-2.00 p.m.) supom —--- N TOWN OF BARNSTA Building Permit Application i Pro'ect Street Address 1665 Main St. 3 Village Cotuat Fire District w fhvncr John R. >lblnigreri Address 49 Buckingham Way, Cotuint Telephone 426-0620 583-2595 Permit Request Zoning District ]IF Flood Plain All Water Protection Lot Size 1.2 Acres Grandfathered Zoning Board of ApDeals Authorization Recorded Current Use Single Family Residence Proposed Use Same Construction Type WOOd Frame Eaistine Information Dwelling Type: Single Fariffly Two family Multi-family Age of structure Ntw Basement type Full Historic House Finished Old King's Highway Unfinished X Number of Baths 3 No. of Bedrooms 5 Total Room Count(not including baths) First Floor Heat TvDe and Fuel HOtwd-te by oil Central Air Yes Fireplaces 2 Garage: Detached Other Detached Structures' Pool no Attached X Bam no None Sheds no Other n/a Builder Information Name Douglas A. Ring BuAders Telephone number 238-2038 Address 50 Oliver Street License# 017 017 N. Easton, MA 02356 Home Improvement Contractor# Worker's Compgnsation # W l-312-497519-014 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 Off Cape Salvage Yard WTY`_11 PS - Wl 1 der Si �B ackton Proiect Cost Jy; U W Fee / SIGNATURE DATE s BUILDING PE DENIED FOR THE FOLLOWING REASON(S) BPERM T V Y TOWN OF BAR14STABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION - Please print. DATE 10/17/94 1665 Main Street COtuit, Massachusetts JOB LOCATION Number Street Address section-,'Of- Town ".HOMEOWNER" John K. HO-lmgren 508-5837366 508-583-2595 Name Home Phone Work Phone PRESENT MAILING ADDRESS 1308 Belaont Street Brockton; Massachusetts 024-al City/Town State Zip Code The current exemption for "homeowners" was extended to include occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, -Provided -that the owner acts as supervisor. zr 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 to six 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, by-laws, rules and The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements HOVLEOW14ERIS SIGNATURE bS-•�� APPROVAL, OF BUILDING OFFICI Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127 . 0 , Construction Control. A xzscs COMMONWEALTH OF MASSACHUSETTS —�� DEI'AI---1`fE.NT OF rNTDUSTRLAL ACCIDENTS 600 WASHrNGTON STREET fames Camooei' BOSTON, MASSACHUSETTS 02111 �o- sstone WORKERS' COMPENSATION INSURANCE AFFIDAVIT 1 Doug A. King , of Douglas A. King Builders (licensee/permincc) .s'ith a principal place of business/residence at: 50 Oliver St. N. Easton, MA 02356 (City/State/Zip) do hereby certify, under the pains and penalties of perjury, that: [x] 1 am an employer providing the following workccs' compensation coverage for my employees working on this job. Liberty Mutual W l-312-497519-014 Insurance Company Policy Number [ ) l am a sole proprietor and have no one working for me. [ ] I am a sole proprietor, general contractor or homcowncr(circle one) and have hired the conrmaors listed bclov- who have the following workers' compensation insurance policies: Dame of Contractor f Insurance Company/Polio}' Number Name of Contractor Insurance Company/Policy Number Name of Contractor lnsurancc Company/Policy Number 0 1 am a homcowncr performing all the work myself. NOTE: Plcasc be aware that wbilc homeowners wbts employ persons to do maintenance,construction or repair work on : dwelling of not more than three units in which the homcowncr also resides or on the grounds appurmnant tbereto arc not general])• considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)), application by a homcowncr for a license or permit may evidence the legal sutus of an employer undcr the Workers'Compensation Act- 1 understand that 2 copy of this statement will be forwarded to the Department of Industrial Accidents' Ofriee of Insurance for.eovcratc verification and that failure to secure coverage as required under Section 25A of MGL 152 can]cad to the imposition of-f-timinal pcnaltics consisting of a fine of up to S1500.00 and/or imprisonment of up to one year and civil pcnalues in the form of a Stop Work Ordcr and a fine of S100.00 a day against MC. Signed t 's /_2 f day of /J �� 19 Licensee/Permi e Licensor/Permlrcor J.K. HOLMGREN & ASSOCIATES INC. Registered Professional Engineers,Land Surveyors and Environmental Consultants 1308 Belmont Street,Brockton,Massachusetts 02401 Tel. (508)583-2595 Fax(508)588-7518 October 20, 1994 Town of Barnstable Building Inspection Division 367 Main Street Hyannis, Massachusetts 02601 Attn: Mr. Ralph Crossen Building Commissioner RE: 1665 Main Street ' Cotuit, MA Dear Mr. Crossen: As you might recall, I am the prospective buyer of the above referenced property and am in the process of having plans prepared to obtain the building permit. Before I can acquire the property, my bank is requesting that I receive correspondence from your office that simply states that a building permit will be issued upon receipt of plans which conform to the State building code and the Town of Barnstable Rules and Regulations, along with the appropriate fees. I have enclosed a copy of the Building Permit Application which has been endorsed by the respective agencies as well as other supporting documentation which certifies as to the amount of upland on the lot. Since my closing date is scheduled for the end of next week, it would be greatly appreciated if you would address this matter at your earliest convenience because the seller will not rant an further time extensions. The letter h 1 g yshould be addressed to: Mr. Peter Curtin, Sr. Loan Officer Campello Co-Operative Bank 1090 Main Street Brockton, MA 02401 If it would expedite matters, I would be happy to pick up the letter at your office and hand deliver it to Mr. Curtin or you may fax it to our office at (508) 588-7518.Thank you for your anticipated cooperation. Very truly yours, roK. gren, P.E. JKH:rl Land Surveys • Subdivisions Septic Design • Wetland Filings Site Design Environmental Site Assessments -------------------------------------------------------------------------- 2x T-j- Blui ift' ll-l" sEp I 17-ROPLTY WiNp TOWN OF BARNSTABLE, MASSACHUSETTS WING DATE SC� •tf-411lbL-r k9g 19 94 PERMIT NO. &9 37064 APPLICANT Owner AODREss 1 Pleasent Park Dr. My l3rlfw - NUMBER OF Demolish OWELI.ING UNITS PgRMIT TO STORY Dwellirt4 (Type OF ImppovemeNY) No, (PA0posro use] ZONING AT (LOCATION) 1665 Maiii Str (C'L, Colu'i t DISTRICT_ tNa,) (srllegTl IBETWEEN (CROSS STREET) AND (CRO55 STREET) LOT SUBDIVISION LOT BLOCK SITE allILDINr, IS TO 89 LONG GY FT, IN MEIGHY AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: I. AREA OR PERMIT VOLUME ESTIMATED COST $ (CWbIt/SQUAR& FEET) - PEE No/Ifee OWNER Romas Rackauskas -71=easant Park Dr. ilclshpe-c a U I 1,0 1'N PT ADDRESS BY II OF ANY APPLICABLE SW501YISION RESYRIC:TIONS, MINIMUM OF THREE CALL. APPROVED PLANS MUST BE RETAINIZQ ON JOB AND THIS WHERE APPLICA8LE $$.PARATE INSPECTION5 REQUIRED POR PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT PASTED UNTIL FINAL INSPECTION HAS BEEN EPLEC Y4RICAL, PLUMSINO AND ': FOUNDATIONS OR FOOTINGS, MADE,, WHERE A CERTIFICATE OF OCCUPANCY IS RE. MECHANICAL INSTALLATIONS. 2 PRIOR TO COVERIN4$ $YRUCTURAL CUIRED,SUCH BUILDING SHAi-i-NOTaE OCCUPIED UNTIL MEMBERS(PEACY TQ LATm). 3. FINAL INSPE�;TION BEFORF FINAL INSPECTION HAS BEEN MADE, OCCVPANC;Y. POST THIS -CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBINf,INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I t 2 2 HEATING INSPECTION APPROVALS ENG)NURING DEPARTMENT 2 BOARD 00 HiALTH OTHER SITE FLAN REVIEW APPROVAL WORK SHAt,I, NOT PROCEED UNTIt,THE INSPk. F?ERMIT f'!LL BECCimE NULL AND VOID IF CONSTRUCT ION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HA$APPROVED THE VARIOULIS STAGES 00 WOR 15 NOT STARTED WITHIN SIX )AONTHS OF CIATS Tj4V `104hAtIG66 i:um bl"' TELCPHONE UH WriiTrEN IT IS ISSUED AS NOTED ABOVE, NOTIFICATION. - ---------------------------- 77--------------------------------------------------------------------- - ---- , 8 'Y F 3 p • a�a • fJ�wr F�. co A H I t t3R 3< I w �J4•I-��i 11 FLdO(L Ttq� � I 111��. �} F�.�S.T• I �WC� I�LrTv wrwov®ev: SCALE: IL.•;�•,0•• oawwnev�r owra: -S aevNNKWD { DRA%Vma+nr>reeq naM w�aoo�araaaw.�.r. N - 'NOTES o¢i 01, 1. TOP OF FOUNDA TION ELEV. = 14. l I , , w W / 2. BENCHMARK' TOP OF CB ELE V. = 8.09 PER PLAN REf , M _,�a ►• �iJ 3. FLOOD ZONE • Al / - ELEVATION - //. 0 r, h /` rxpriry rMAr rf.Ir pit//'n/A/G cnl/MnArinAt FDN TOP �— /3.0 i FOOT/N G SH GRADE OVER LEACHING CHAMBER First 2'to be set le p min)" -- 6'aump Lj DISTRIBUTION BOX PRECAST LEACHING TO BE INSTALLED ON CHAMBER A LEVEL STABLE BASE /8 OUTLETS REQUIRED 9 REQUIRED TO BE INSTALLED ON A Ec ,=i, 70 LEVEL STABLE BASE NOTE SEPTIC TANK TO BE INSPECTED 8 CLEANED ANNUALLY DESIGNED SYSTEM CONSISTS OF `l /Z 05 TYPICAL SYSTEM PROFILE FINISH GRADE- NOT TO SCALE FINISH GRADE OVER TANK-. 10,5 FlNI 8"r,REINFORCEO in.) 3 riun —'�6"(min.)— C. OR . TEES CRETE P. 1-500 GAL. SEPTIC TANK DESIGN SCHEDULE I ELEVATION TOP OF FOUNDATION_ 13.00 _ _ 'FINISHED BASEMENT FLOOR '7, 00 FINISHED GARAGE FLOOR _ l 2 . SO _ SEWER INVERT AT FOUNDATION _ 9. 0 y _ _ SEWER INVERT INTO SEPTI C TANK 8. 7& SEWER INVERT OUT OF SEPTIC TAN_ K 8. 5 I SEWER INVERT INTO DIST. BOX 8•. l7 SEWER INVERT OUT OF DIST. BOX SEWER INVERT AT END OF SYST_ EM 7.70 WA TER TABLE _ 1.70 LEACHING CHAMBERS SURROUNDEn BY 4 FFF T OF 3/4 " I l/ 2 " WASHED STONE CAPPED BY ,3 " PEA STONE vi / 6 OF sTon)45 C'NDS,l I DESIGNING ENGINEER LqW SASE s�irgr� v� c�anFlr �I wRlrwo 00 m QD. - � — ' m A.w.�A.e onednu.d / �N- co ---------------------- EVE UdTER Benchmark GENERAL NOTES w /� l ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH h — `t TITLE St OF THE STATE SANITARY CODE DATED JULY 1, 1977 8 ANY LOCAL Tank - l l RULES APPLICABLE. 2. ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING i- � gCAL R10. F . BY JOHN K. HOLMGREN PE I 3. WHEN CONSTRUCTION IS COMPLETED PRIOR TO BACKFILLING, NOTIFY THE ENGINEER 8 BOARD OF HEALTH FOR INSPECTION. uvrr OF WORK 4. FOUNDATION ELEVATION MUST BE CHECKED WHEN COMPLETED. �... TAKEN FROM (SITYPWSR 1 " I \ +J � 5. THESE ELEVATIONS MUST NOT BE CHANGED WITHOUT WRITTEN APPROVAL BY TP .k - ___ JOHN K. HOLMGREN PE i 6. ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4" PVC C. 4 � � LOTS 38 9 13 ' � of � 7. USE ROTONDO FD 4 X 8 - D FLOWDIFFUSORS (OR APPROVED EQUAL) a e 1 1. I ' 20 Acres .. R /A o 0� J � yti ; l 1 rOB�FF� I—_ O CALCULATIONS LEACHING AREA REQUIRED Bedrooms of /fd GPD/BR = . 590 GPD Additional 50% for Garbage Disposal NIA GPD TOTA L GPD PERO RATE 2 MIN./INCH AA Required- 550 GPD /0.75 gpd. s.f. = 733.3 S. F. AA Provided = 45' x l7' = 742 S. F. LEACHING AREA ( See Plon Reference J SOIL LOGS CAPE # ,SCAND SCALE : l"= #' I.c1/rNa7cxS .p• M109AND1 DATE 5- 21 - 92 ENGINEER 1=NGwE:uR1NCw cd• BOARD OF HEALTH AGENT BARNS . TEST PIT l Elevation= 8.'10 T-0PSo (L 4 Su [3So(1— Z' IuM `. SAND 7.5 to' TEST PIT 2 Elevation = TEST PIT 3 Elevation = TEST PIT 4 Elevation = TEST PIT 5 Elevation = . 1. PLAN REFERENCE: SEE PLAN ENTITLED, y'SITE PLAN`, OF LAND LOCATED IN BXRNSTABLE-COTUIT-i LASS..' `PREPARED FOR RONALD RACKAUSKAS." PLAN 952792 DATED MAY 27, 1992, PREPARED BY CAPE & ISLANDS ENGINEERING. 2. FLOOD ZONE: Al - ELEVATION =>I1.0 DISTRIBUTION BOX SEPTIC SYSTEM DESIGN TAKEN FROM "PI AN ALL OUTLET PIPES TO BE EQUIPPED WITH REF'ERENCESHOWN HEREON . 'SPEED LEVELER' BY TUF - TITE OR EQUAL. /tiA ZZ . 7 (rye, -10a ZONING DISTRICT: MINIMUM ZONING REQUIREMENTS FRONT SIDE REAR: DESIGNING ENGINEER MUBT 1V18�, INSTALLATION AND CERI FY N WR MM THE SYSTEM WAS *MIX Ep I1 $1R101 ' ACCORDANCE TO PLAN." ` a CERTIFY THAT THE SEWAGE DISPOSAL SYSTEM SHORN HAS BEEN DESIGNED IN ACCORDANCE WITH TITLE 5 Of' THE STATE ENVIRONMENTAL CODE AND THE RULES 8 RE'GUL A T IONS OF THE LOCAL BOARD OF HEALTH. LEGEND EY/ST/NG CONTOURS PROP03ED CONTOURS EXISTING ELEVATIONS PAVPOSED El EVAT/ONS TE`S T PIT DESIGNED BY; SEE PLAN REFERENCE 99.00 — — DRAWN BY.- CHECKED 990 — T H E J K H 99X00 SCALE: DRAWING 4 O' DATE: /0-14- 94 JOHN'I K. klA, J HOLMGREN O/V SITE SANITARY DIISPOS4L. � YSTEM Lots 3B AND 13 MAIN ST. BARNSTABLE- CO TUI T - M A . J. K. HOLMGREN 8 ASSOCIATES, INC. REGISTERED PROFESSIONAL ENGINEERS AND LAND SURVEYORS 1308 BELMONT STREET B ROCKTON, MASS. 02401 LOCUS MAP Scale: 1" = 2000' D.E.P. File #SE 3.4481 CONSERVATION NOTES: 1. NO WORK IS TO BE DONE UNTIL FORMS A & B ALONG WITH REQUIRED PHOTOGRAPHS ARE SUBMITTED TO CONSERVATION COMMISSION. 2. ALL ROOF LEADERS TO DISCHARGE TO DRYWELLS. 3. LANDSCAPE MITIGATION PLAN TO BE SUBMITTED BY HORIUCHI - SOLEN FOR APPROVAL BY CONSERVATION COMMISSION STAFF. i IL LOT 30 N L.C. PLAN 16194 / N/F DONALD T. GOLDBERG TR. Jk AL S JOAN M. GOLDBERG TRUST , gbh F ' INVERTEL -PIPE- ILO �p BORDERING VEGETATED Alk ; x 3\ik,9 WETLAND ` 4, a� WF A Alk 4,113��` x A-116 \3 6x 4.2 AV LOT - i 5 t ��x 7.5 T4P AN Cj W L.C. PLAN 16194 J WF A-1 3,0 - I, �` O D - p - 100' OFFSET FROM ' A p `\ �TC'/�r WETLAND FLAG LINE /y AL /TC 5.0 z WF A-11 WOODED J LOT 'A �'� \ 6 . X,-DJO 1z' x 7' / L.C. PLAN 16194" LQ�3B� 7� �,Hq\G, • Z+ 7.3 �.s N/F DONALD T. GOLDBERG TR. -'I1LAN 16194E 8 4 t S�Cp \ • \ ` A\f' - '' "�`~ JOAN M. GOLDBERG TRUST WF A-94,0 , , 6,7 1 ,8 T \� T � \ A► x 7 TOp L.C. PLAN 16194 J �,' 5.8, $ 4 \`FENCE 08 \ --- 07p�0AF 4,8 WF B-1 REM N/F DAVID G. MUGAR ' / Q _ _ 8,0,.�� \ x 5.3 y / 7 1 . .' / / VIf�yL _� CE � _ JJ � O 7,0 g 4,3 �l/� 7.4 �u T x 7.1I \ 5� 4.9 IMF B-2 8,7 *---- i 70 - ---�-----------��__ � -- ------ Op �� 3.7 l0 _� _ - --- 7,8 O O WF A-8 �' - x- - I rPROPOSED 500 GAL 07 DA 6.1` 3 016 "- CRUSHED o LEACHING CATCH BASIN �l WITH 4 OF STONE _ / / / 4.3 CB FND 11 - 11, ,� 1 '� INVERT 12" PIPE 1 10.0 8.3 ----- -- - 9.� / ' EL = 0.6' I - AL 11.3- ? % 4.3 AL / t 9,4x --\ / / HATCHED AREA TO BE / / / LAWN �1 f WF B-4 REPLANTED WITH NATIVE VEGETATION x10 cs \ �� 0 i f WF A-7 4,2 I A S OWER / P�C.�LD 1 CHIPSEAUBRUMI ��y x ri rf IF 4.7 AL 7� � CLOSU GP� 14 PA EMENT rr 7 f 6,9 ,� WF B-5 BORDERING VEGETATED r % �D �/ G• 11.6 - , usy O O it l jlf l WETLAND AL �.2 , Qo 72 AL WETLAND FLAGS B-1 - B-12 PER SAMUEL HAINES 9 !�//� 11,8 I 11 ,< 0 ;/ / /�� OF ENSR INTERNATIONAL 6-16-05 1-01N I Il 8, r/ 3� WF B-7 LQ Alk A l I/ . �// r 0 2 STORY \ 0 �A I / 7,8 r/ 11 / / / / 9, / \� D\wELUNG Me 1 1 i i WF B-8 If 6B DPI FI �.9 ( Q F,F,E : 15 W-,5. x 818 4,7 / o Q 56 - x WF A-5 IW 1 1 11.7 55 - ! K Bic z 12.1 m I 1 rr / , t o Q AL 11.9 4i /. CB LP D , , r / 1 � r I " f / i ' �' i Ir �' BORDERING VEGETATED WETLAND FLAGS A-1 - A-16 PER SAMUEL HAINES 12 r ' 41 x 1 % W L RET. ti o �0 rr �r 3.4WF B-9 WETLAND 8, r OF ENSR INTERNATIONAL 6-16-05 f 1 ` /, W rl x 8.4 rl % J I I Ix8,3 ` 2. �� 6 7. 4,8 t �\ 1t 10,7 11,8 `jq �% rr ,! 4.7 WF//B-10 WF A-4 1 -. 0 AL �Nk x 10 7 f 1 AVVN / r l r LOT 12 L.C. PLAN 161941 N/F DAVID G. MUGAR LEGEND / ABBREVIATIONS = LIGHT POLE = UTILITY POLE C. = GUY WIRE ® = MAIL BOX ® = ELECTRIC METER ® = GAS METER G = MARKED GAS LINE - « - ON%-- «�►- = OVERHEAD WIRES = TREE LINE o = CONCRETE BOUND EL = ELEVATION CB = CONCRETE BOUND LP = LEAD PLUG DH = DRILL HOLE FND = FOUND A WF = WETLAND FLAG F.F.E. = FINISH FLOOR ELEVATION G.F.E. = GARAGE FLOOR ELEVATION EOP = EDGE OF PAVEMENT j� �/ I 0 r f 9.9 DECK COV AL� H 10,6 i ,6 1 / 1t X17 9 - �` x •� r f .7 WF 8-11 RUSHY MARSH .I ' l t � t 1 � � f 1 -/ x 8,4 ! / I i 1 y 7.8 I // I t\ x 10.9 WF A-3 4.3' WOOD�D AL AL +r J �' 1' t L`- f < I I 8 0 ( 100 I ! 3,5 WF B-12 , CB D� FND , A4 /I 0 L 0 I .- I - I 8.4 L O= % !�BOX 19,1 AL Z 7.4 I r / t � � I i f� > 11 i/ t' ;I i j- P -9,d ' a° AL WF A-2 .7 � o 20 I j N C, r �A1 W i I r 4V 1 / -� I LAWN - 9.1 1 5L 1 j p � I '1 1 AL • LOT 3/ L.C. PLAN 16194- 7.8 Q, r t r ' •CV / &LOB 13 LC. PLAN 161�14J �-�' 9.6 _ / Ir cti 6,5 r I' COMBINE TOE CREATE LOCUS ? / / TOTAL PARCEL AREA 52,157* SO. �T. 1. �� _ x 8,5 t r IL 4,8 �7 ,{.20t ACRES �- �-t' �1,�- r IN IL A-1 � � � EL ITBM�=H .07' NGVD Ir � i I I � BORDERING VEGETATED FROM. WETLAND /� ND FLAG LINE 14,'.jMDr / I r i� / 8 9- ND z �� 1.. : ��: CaMS1R .TMPq� i I ' l ACCEft DH fND /� �/ /� WO0 ED \ / ARy RIDU'1� • r 00' PROPOSED 600 GAL c 1 AL LEACHING PIT WITH �` ^• � I I AL ��/ /� �� 2' OF STONE FOR / SWIMMING POOL PUMP OFF N �I 4' WIDE LAWN PATH , W ro N 7828, i5 0 1 1 a 31 • 100 OFFSET FROM , WETLAND FLAG LINE i i g . AL 6.4 ,O 1� / 00 LOT 3 A \ L.C. PLAN 16194 B N/F ANDREW L do JAMIE K. STERN 6.114 I I I r I � J I r � I � J r I ' 50, i WF A-6 � I d- J I I I C� FND I es, I on AL GENERAL NOTES: 1.) THE INTENT OF THIS PLAN IS TO DETAIL EXISTING SITE CONDITIONS AT LOCUS. 2.) LOCUS AREA IS COMPRISED OF : LOT 313 L.C. PLAN 16194 B - LOT 13 L.C. PLAN 16194 J (SITE) LOT 4B LC. PLAN 16194 B BARNSTABLE ASSESSORS MAP 017 PARCEL 002 0° CERTIFICATE OF' TITLE. 170,163 OWNER: DAVID R. WEINSTEIN & DEBRA Y. HERNANDEZ 23 BROOKS STREET zz WINCHESTER, MA 01890 a 3•) ZONING INFORMATION J ZONING DISTRICTS.- RF RPOD RESOURCE PROTECTION OVERLAY DISTRICT AP AQUIFER PROTECTION OVERLAY DISTRICT MINIMUM CURRENT ZONING REQUIREMENTS - ZONE RF MIN. LOT AREA = 2 ACRES (RPOD) MIN. LOT FRONTAGE = 150' FRONT YARD == 30' SIDE & REAR YARD = 15' A 8 LOT 4 L.C. PLAN 161940 N/F DAVID R. WEINSTEIN & DEBRA Y. HERNANDEZ on WETLAND FLAG A-6 PER SAMUEL HAINES OF ENSR INTERNATIONAL 11-30-04 LOT 4 A L.C. PLAN 16194E N/F ANDREW L do JAMIE K. STERN 4.) COMMUNITY PANEL NUMBER: 250001 0022 D THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS ZONES B, & A-11 (EL. 11.0) BASE FLOOD ELEVATION = 11.0' 5.) PRIMARY BENCHMARK: RM 46 FIRM MAP CP# 250001 0021 D FLANGE BOLT ON HYDRANT NEAR INTERSECTION OF MAIN ST. & OCEAN VIEW AVE. ELEVATION = 25.82' (NVGD 1929) PROJECT BENCHMARK: SEE PLAN 6.) UTILITY INFORMATION SHOWN HEREIN: LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND MUST BE VERIFIED IN FIELD BY THE CONTRACTOR AND APPROPRIATE UTILITY COMPANIES PRIOR TO ANY CONSTRUCTION. 7.) EXISTING SEPTIC SYSTEM LOCATION PER INSTALLER'S TIE CARD PERMIT #94--613 BY JACK FEIN, COMPLIANCE ISSUED 4/19/95 8.) WETLAND FLAGGING AND DELINEATION PERFORMED BY SAMUEL HAINES OF ENSR INTERNATIONAL ON JUNE 16, 2005. REFERENCE I -LAG BY SAME ON NOVEMBER 30, 2004. 9.) A TITLE SEARCH HAS NOT BEEN PERFORMED FOR THIS SITE. IF DETERMINED TO BE NECESSARY A TITLE SEARCH SHALL BE PERFORMED BY OTHERS. 10.) THE PROPERTY LINE INFORMATION SHOWN IS BASED ON CURRENT AVAILABLE RECORD INFORMATION CONSISTING OF PLANS AND CERTIFICATES. THE EXISTING FEATURES SHOWN HEREON WERE OBTAINED FROM AN ON THE GROUND FIELD SURVEY PERFORMED BY BAXTER, NYE & HOLMGREN, INC. ON JULY 20, 2005 PLAN REFERENCES: L.C. PLAN 16194 B 1665Main Street Cotult, (Massachusetts PREPARED FOR David R. Weinstein, et ux. TITLE Wetlands Permit Plan BAXTER NYE ENGINEERING & SURVEYING Registered Professional Engineers and Land Surveyors 87 North Street, 3rd Floor, Hyannis, Massachusetts 02601 Phone - (508) 771-7502 Fax - (508) 771-7622 20 0 20 40 SCALE IN FEET SCALE: 1" = 20' 2. SA 3/30/06 REVISE POOL & CABANA 1. SAW 2/6/06 REMOVE SPORT COURT NO. BY DAIS REMARKS DRAWN BY: MCL DESIGNED BY: ICHECKED BY: JRE DATE. 12-12-2005 DRAWING NUMBER 0: 2005 05-065\SURVEY\wrksht\2005-065PB3.dwg 2005-065-02 STRUCTURAL NOTES #3 0 12" O.C. E.W. THROUGH OUT ENTIRE POOL WALLS CL ADDITIONAL #3 @ 12" O.C. VERT. BEYOND TRANSITION PT. STAY 18" BELOW TOP OF BOND BM. DOWN THE COVE & LAP 1'-8" MIN. INTO FLOOR AREA �#4 DWL. @ 12" O.C. TYP j— (3)#4 CONT. TYP. 1 TYP, 2'-6" MAX. BACK 4" INCREASE TO 6" ``� FILL ALLOWED IN EXPANSIVE SOILS li. --- - -- -- - - ----- - - --- - - - - - - - - - --- - - - - - - - - - - - --- -- -- I I 1 -- - -- -- -- - - 1 _ �- �- .L_ I �1 2,-6„ BACK - - - - - - - - - - - - - - - - -- - - 1 NOTE: INCREASE SHOTCRETE �. THICKNESS TO 9" IN FREEZING OR EXPANSIVE SOILS, -FIT LLJ — _ r�- -�y. W y '✓� TRANSITION PT. ao v y: O s ADDITIONAL W. 0 FFLOORTRANSIT C)N PT. PI ACF 1" FROM TOP OF SI AR - - - #3 ® 12" O.C. E.W. THROUGH OUT ENTIRE POOL FLOOR IQ V 30 i T—E 2'-6" MAX. BACK FILL ALLOWED J w HYDROSTATIC RELIEF VALVE �U INSTALL PER MANUFACTURER'S roSPECIFICATIONS 1 0 TYP. POOL REINI= ORCMENT SECTION SCALE: 4" = 1 0-0" f,. 5' RADIUS 0 Q L 0XX I � �n HYDROSTATIC RELIEF VALVE INSTALL PER MANUFACTURER SPECIFICATIONS DEEP END 8'-9" DEPTH MAX. TRANSITION PT. 7 1 L SHALLOW END 5'-0" DEPTH MAX. TYP. FOOL CONSTRUCTION SECTION SCALE: T" = 1'-0" Note: All pools shall be constructed to assure dimensional compliance with section 421 of the Massachusetts State Building Code 760 CMR. PLA 0 VN SCALE: 1" = V-0" 2'-6" MAX. BAC FILL ALLOWED MAX FILL 1. All construction is to conform to the Massachusetts State Building Code and all applicable product and design standards. Absence of specific items from these drawings does not infer that the contractor is relieved from the statutory code requirements. 2. All materials and methods of construction shall conform to the approved rules and standards for materials, tests, and requirements of accepted engineering prcctice as listed in Appendix A of the Massachusetts State Building Code, Pool Notes 1. Assume maximum safe soil bearing pressure — 4,000 psf. 2. All pools are to be placed on natural undisturbed material or compacted granular fill. Subsoil bearing strata shall be free from all vegetation, loam and organic material. 4. Do not place backfill against pool walls until all walls have obtained 7 day cure strength. 5. All pool floors shall be placed on a l'-6" layer of crushed stone compacted to 95% Standard Proctor Density where expansive soils are encountered. 6. Pools floors shall bear on natural undisturbed soil or on controlled compacted fill. Remove existing fill material where necessary and replace with clean granular fill compacted in 6"-8" layers to obtain 95% standard proctor density at the optimum moisture content. Shotcrete 1.Shotcrete mixture, form -work, delivery, placement and reinforcement shall conform to all requirements of ACI 506.2--9t (latest edition), unless otherwise noted. 2. Concrete materials shall be: ASOM C Type 1 Portland cement. Sand and gravel aggregates shall be normal weight and conform to ASTM C33 Standards. Aggregate not meeting ASTM C33 standards may be used provided pre construction tests demonstrat the Shotcrete can rneet specified requirements. All c rete shall be air -entrained. Concrete compressiv strength, (f'c) in 28 days, shall be in accordance with 1 318-02 as follows: All concrete work - 3,000 p 3. All mixing, transporting, placing and curing of concrete shall be done in accordance with the recommendations of the American Concrete Institute, 2. Reinforcing steel sncul oe deformed bar contorming to ASTM A615, grade 60, except where noted, No. 3 bars may conform to ASTM A615, Grade 40. All reinforcing bars welded to a steel section should be of welding grade 40. SYM. 2'-6" MAX. BACK FILL ALLOWED 5' RADIUS X I Q cn m 0 I 00 HYDROSTATIC RELIEF VALVE SCALE: i" = 1'-0" SYM. OASTAL NG ERINNG } ' OMP , INC. 260 Cranberry Hw18.255.6700 fleans, MA 02653 508.255.651. Fax: SEAL S. /4t '0s- 0i z 0 CX O z 9 0 0 L e 0 VJ W0 J W c3 LU (L j cn SCALE AS LATEST REVISION DATE ATE 2'-6" MAX, BACK O o DRAWN BY FILL ALLOWED iI N E - II Q CHECKED BY 11- 2' RAD. in N Q C 0 U o+ c SECTION B a� C SCALE: 1" = 1,-0" w` 4 OF 1 SHEETS 0 U PROJECT NO. C 159