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HomeMy WebLinkAbout0100 OREGON WAY 0/170-7-k- ACT" VI`E it �r k 1 k 779--�h/ /Cpl- ' O �P 3 l� �,,,� a-�? ��' ? �ht.D�e a►-�q1`Y►�-5 Cc,',e�'���7a�'s� i iee�3 rvt�c-51-� Joe, used . � ---- ----- -_��---�--� ------i --� � G� A / � f K' G� V W �.� � `� I �.�,�- PROJECT ? NAME: ADDRESS: ` -,J PERMIT#p7G� S PERMITATE: M/P• D LARGE ROLLED PLANS ARE IN i- BOX SLOT' 0 --3 Data entered in MAPS program on: 0 BY: q/wpfiles/archive �tTE v�st^r �Jd31oy � - auk L-'r f �- rg TOWN OF BARNSTABLE BUILDING PERMIT APPL , bid Map J[v P,ecbl � _ ; AOtelissue'd' on-# Health Division "' - D t-1� •� �`H Conservation Division� / y Application Fee �Ct� Planning Dept.t. Permit Fee ""`"" too Date Definitive Plan Approved by Planning Board' Historic'- OKH Preservation/Hyannis ' 01R Project Street Address 100 0 RE Ohl 1N A Y O0 i`i" r MA- Village - r € Owner Address II DAY96 W HIUL, 1 � c Telephone C, D v eauje.s`j' 5, ��17 �IG� ��01� i �t�� � �I 1f� of (® 0 26 t Permit Request PI P'(.( L Ia H lw1: 'I06 VVJ1F � Ih &,Y 1201LE? �4,10 R, 7 Square feet: 1 st floor: existing At-h-proposed 2nd floor: existing NIA proposed , Total,aew 7 P Zoning District Flood Plain A 'Groundwater Overlay Project Valuation 4 Construction Type WW FKAME '- Lot Size ACRCS Grandfathered: t❑Yes A No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ _' , Multi-Family(# units) Age of Existing Structure %00'005 Historic House: ❑Yes ANo On Old King's Highway: ❑Yes No Basement Type: ;Q Full Crawl ❑Walkout ❑ Other i Basement Finished Area(sq.ft.) ® Basement Unfinished Area (sq.ft) 4-'5'69 `-' Number of Baths: Full: existing new 1r Gi Half:existing new Number of Bedrooms: P J A existing new Total Room Count (not including baths): existing new First Floor Room Count dy Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑ Other Central Air: XYes ❑ No Fireplaces: Existing LNew Existing wood/coal stove: ❑Yes )W Na Detached garage: ❑ existing new size—Pool: ❑.existin ❑ new size _ Barn: ❑ existing g g g rrss�� g g ( new size_ Attached garage: ❑ existing ;I new size�4_5hed: 0 existing ❑ new size _ Other: 1A Zoning Board of Appeals Authorization ❑ Appeal #- ' Recorded ❑ Commercial ❑Yes No If yes, site plan review# Current Use ALo C,6 Proposed Use _AI`a!OFNTl6 L-- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address License # C 5 I 5 f Home Improvement Contractor# Moll -Workers Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO_ .�_ SIGNATURE �;:7kL7f DATE � ; e 2-le) _ 777 FOR OFFICIAL USE'ONLY \ APPLICATION# i DATE ISSUED MAP/PARCEL N0. - M ADDRESS VILLAGE ` ~OWNER ! -DATE OF INSPECTION: A#Aexlkolg _ 'FOUNDATION Af c « �� -of-b *tsv J /o dv *tAaZ''� i vto ,*I t -FRAMEsfl lbdfi2tK a�o�`-� t{ s ./ 0/0 R �� Gb �� 'xYvOSk- WAIV INSULATION d�C�''���� + o K of Tt FIREPLACE k I1 b oye_w 4 e I 7"k 'ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL k `GAS: ROUGH FINAL FINAL BUILDING P gyp DATE CLOSED OUT ASSOCIATION PLAN NO: Town of Barnstable Budding Department - 200 Main Street. sARNSTABLE. * Hyannis, MA 02601 9�b 6� ,�' (508) 862-4038 QED MA'S A Certificate of Occupancy Application Number: 200902400 CO Number: 20110117 Parcel ID: 016012 CO Issue Date: 08/16/11 Location: 100 OREGON WAY Zoning Classification: RESIDENCE F DISTRICT Proposed Use: SINGLE FAMILY HOME Village: COTUIT Gen Contractor: E.B. NORRIS & SON, INC. Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: CARRIAGE HOUSE ONLY C.O. Building Department Signature Date Signed k y INEr � TOWN OF BARNSTABLE. 80dn''g . Application Ref:. 200902400* BARNSTABLE, # Issue Date: 07/14/09 P e r I m,i MASS. gap 039• ��� Applicant: E.B.NORRIS &SON,INC. Ar�O MAC a Permit.Number: B 20091224' Proposed Use: SINGLE FAMILY HOME Expiration Date: 01/.11/10 Location 100 OREGON WAY Zoning District RF Permit Type: GARAGE DETACHED RESIDENTIAL Map Parcel 016012 Permit Fee$ Contractor E.B.NORRIS&;SON,INC. " Village COTUIT App Fee$: r. License)Num"' `015B1 Est Construction Cost$ �N Remarks APPROVED PLANS MUST BE RETAINED ON,JOB AND C CARRIAGE HOUSE J I BED, 1 BATH AND 1 CARATTACHED GARAGE THIS CARD MUST BE KEPT POSTED UNTIeFINAL 3NSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: REILLY, GRETCHEN A BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: PO BOX 587 INSPECTION HAS BEEN MADE. COTUIT, MA 02635 Application Entered by: RM Building Permit Issued By. )Ock THIS PERMIT,.CONVEYS NO,RIGHT TO OCCUPY'ANY:MEET' SIDEWALK OR ANY;PART THEREOF,EITHER TEMPO RARILY,OR PERMANENTtiY: ENCROACHEMENTS ON PUBLIGPROPERTY,NOT SPECIFICALLY PERM.ITTED'ONDER:THE'BUILDING CODE,MUST'BE APPROVED BY THE JURISDICTION. STREET OR ALLY GRADES AS WELL AS DEPTH'AND,LOCATION OF',PUBLIC SEWERS MAY BE:.OBTAINED FROM:THE'DEPARTNiENT OFPUBLIC 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 CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTINGp WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). Yx c ti BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS rs cm _r c& 3 1 Heatigg Inspection Approvals Engineering Dept Fire Dept 2 f"' s /� of C / Town of Barnstable Regulatory Services kL S& - Thomas F. Geiler, Director i6sq` ,Building Division ; Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 ww)v.town.barnsta b le.ma.us Office: 508-862-4038 « Fax: 508-790-6230 PLAN REVIEW , Owner: .7oyce Map/Parcel: Project Address/� mi��tnzJ er -Builder: ; /y� S The following items were noted on reviewing: Ila gs,r- /:s /g) r000 ZEE ,&'C S T 7X0 CtR R 42-0.6- c ArE Teo C ZO, fr 5-V 2— CPX /90%r'f2dT/�d �t oo f/c=iV TiN� 7�'o C,6/h'/Z�(s6ol.Y e#12- �4X�`Lturzt G/OT 7`"�201� �i4�bE �`° o� 710 /t- Grff ViUoT �SCGE C .� E l`��,�KI 6//Ours AIOIIZox .To rEEz: Reviewed by: Date: Q:Forn�s:Plnrvw r Town of Barnstable Regulatory Services Lr- Thomas F.Geiler,Director 1 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 2 ,'as Owner of the sublect.property.. hereby authorize 6We2r 0, WW ! vM. IQC,. to act on my behalf, in all matters relative to work authorized by this building permit application for. -100AWK) WAY , W-Orrl ,hk (Address ofjob) signs Owner. 457 Date Print N IfTroperty Owner is applying for permit please complete.the Homeowners License Exemption Form on the re M;se. side. F Q:FORMS:O WNERPERMISSION � a i Board of Building Regulations.and Standards g Construction Supervisor License i License: CS 15851 t Yj. Birthdate 9/28/1953.• ' Expiration 9/28/2009 Tr# 2366 Restnction ' 1 CRAIG N ASH 6' { HYANNIS 1MA 02601' Commissioner, ,j ; ` 4 i �✓ae -Po�.,v;l.yzi ✓�aaeac�i..�asll . . ,. - ( Board of Building Regulatiohs and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: I jV Board of Buildin Re ulations and Standards Registration 102014 g g Expiration 6730/2010 Tr# 268470 One Ashburton Place Rm 1301 i Type Private Corporation Boston,Ma.02108 ERNEST B.NORRIS&SON INC ,; 11-41 Craig Ashworth f 138 Osterville W. Barnstable rd r y Osterville, MA 02655 Administrator Not valid without signature The Commonwealth ofMassachusetts Department of Industrial Accidents, office pf.Investigations 600 Washington Street Boston,MA. 02111' fvww.mass.gov/dig Workers}Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information .Please Print LeEibly Name(Business/Organizationadividual): �- •Address: 1410 O�iERU�L�C.�-\J 1bA:K0 S�-!'��r Lo City/State/Zip ®S iA> ��I . �� b 5 S� Phone..#: (C,OS� Are you an employer? Check the appropriate bog: :Type of project(required) 4. I am a general contractor and I IN I am a employer with 0 6. 2 .New construction . employees (full and/or part-time).*• have hired the stib-contractors 2,❑'I am a'sole.p'roprietor or partner-' listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These`sub-contractors have> g, Demolition` uVorl ng for me in any capacity. employees and have workers' 9. Building addition comp,insurance.$ ' [No workers comp,insurance lectrica E 10. l re airs or additions required.] 5. ❑.We are a corporation and its ❑' P 3.❑ I ama homeowner doing all work . ' . officers have exercised their 11. Plumbing repairs or additions ' myself.[No workers' comp. right of exemption per MGL 12,❑Roof repairs c. , 1(4), we have no insurance:required.]f 152and§ . 13.7 Other employees, [No workers' comp:insurance required.] , *Any applicant that checks box rl must also fill out the section below,showing their workeis'compensation policy information. t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box mutt attached an additional sheet showing the naive of the Subs-contractors mid state whether ornot those entities have ' employees. If the sub-cont•actors have employees,they must prdvide their workers'comp:polidynumber. I am an employer that is providing workers'compensation insurance for my employees. Below 1sahe policy and job site> information. Insurance Company Name: Policy#or Self-ins.Lic;#:' Expiration Date; 0-b Job Site Address' (Lo p0 VIP AY,' City/State/Zip-a0TV 1T' Attach a copy of the workers' compensation policy declaration page'(showing the policy numb er.and eipiratioa date). Failure,to secure coverage as required under Section 25A of MOL c.152 can lead to the imposition of criminal penalties of a fine tip to$1,500,00 and/or.one-year iniprisonment,as Well as civil penalties in'the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the!Office of Investigations of the DIA for insurance coverage verification. I do hereby certi der the p 'ns•and penalties of perjury,that the information provided above is true and correct. Si afore Date: O• Phone#: J�Q �} 6 Offtcial use"only. Do not.write in this area,to be completed by,city or town official City.or Town: Bermit(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: #: -. ' Client#:646400 2NORRISEB qr _O KD DATE(MM/DD/YYYY) v •` CERTIFICATE OF LIABILITY INSURANCE 5/21/2009 PRODUCER ; THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION - r' Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW._... 973 lyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER A: Acadia Insurance E.B.Norris&Son.,Inc. INSURER B: 138 Osterville-West Barnstable Road INSURER C: Osterville,MA 02655 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MMIDD/YY LIMITS ' A GENERAL LIABILITY CPA005234520 05/03/09 05/03/10 EACH OCCURRENCE $1 OOO OOO,_ nCOM MERCIAL GENERAL LIABILITY - DAMAGE TO RENTEDPREMISES(Ea occurrgl=) $250 OOO CLAIMS MADE a OCCUR " - - MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 000 000..:.< GENERAL AGGREGATE $2 OOO O6O..<.:.... GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-'COMP/OP AGG $2 OOO DO.O_.- POLICY LOC PRO- JECT A AUTOMOBILE LIABILITY MAA005233820 05/03/09 05/03/10 COMBINED SINGLE LIMIT $ ' ANY AUTO (Ea accident) ALL OWNED AUTOS - - _ BODILY INJURY $1 OOO OOO X SCHEDULED AUTOS (Per person) e e X HIRED AUTOS BODILY INJURY $1,000,000 X NON-OWNED AUTOS _ (Per accident) PROPERTY DAMAGE $SOO OOO (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - - EA ACC $ ' OTHER THAN ' AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ d A WORKERS COMPENSATION AND WCA021246412 05/03/09 05/03/10 X DRY We STATUS orH- EMPLOYERS'LIABILITY -' --ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $500,000 J -_- _ OFFICER/MEMBER EXCLUDED? NO E.L.DISEASE-EA EMPLOYEE $500,000':'_'''. :!si_;:�Y_ If yes,describe under - SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS I, Officers are included under the workers compensation policy. Insurance coverage is limited to the terms,conditions,exclusions,other - limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the '4 coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEE RATLO. Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS V ITTEN;.,: 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SQSHAL4 Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. - t AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 sof 2 #S57998/M57992 Gr �LS1 .© ACORD CORPORATION_1981 p3 e � REScheck Software Version 4.2.1 . Compliance Certificate Project Title: Joyce Residence Energy Code: 2006 IECC Location: Cotuit, Massachusetts Construction Type: Single Family Building Orientation: Bldg.faces 90 deg.from North Conditioned Floor Area: 4994 ft2 Glazing Area Percentage: 18% Heating Degree Days: 6137 Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor: 100 Oregon Way Timothy Luff Cotuit,MA 02635 Archi-Tech Associates,Inc. 6 School Street Cotuit,MA 02635 508-420-5335 Compliance:1.9%.Better Than Code won -M. Ceiling 1:Cathedral Ceiling(no attic) 2155 38.0 0.0 58 Ceiling 2:Flat Ceiling or Scissor Truss 3277 38.0 .0.0 98 Wall 1:Wood Frame, 16"o.c. 1891 19.0 0.0 93 Orientation:Front Window 1:Wood Frame:Double Pane with Low-E 267 0.340 91 SHGC:0.49 Orientation:Front Window 2:Wood Frame:Double Pane with Low-E 30 0.320 10 SHGC:0.49 Orientation:Front Door 2:Solid 28 0.290 8 Orientation:Front Door 5:Glass 18 0.320 6 SHGC:0.49 Orientation:Front Wall 2:Wood Frame,16"o.c. 1623 19.0 0.0 89 Orientation:Right Side Window 3:Wood Frame:Double Pane with Low-E 120 0.340 41 SHGC:0.49 Orientation:Right Side Door 3:Glass 20 0.320 6 SHGC:0.49 Orientation:Right Side Wall 3:Wood Frame,16"o.c. 2439 19.0 0.0 106 Orientation:Back Window 4:Wood Frame:Double Pane with Low-E 395 0.340 134 SHGC:0.49 Orientation:Back Window 5:Wood Frame:Double Pane with Low-E 12 0.320 4 SHGC:0.49 Orientation:Back i Door 4:Glass 271 0.340 92 SHGC:0.49 Orientation:Back Project Title: Joyce Residence Report date: 05/29/09 Data filename:C:1Program Files\Check\REScheck\Joyce Residence.rck Page 1 of 2 y Wall 4:Wood Frame,16"o.c. 1560 19.0 0.0 80 Orientation:Left Side Window 6:Wood Frame:Double Pane with Low-E 135 0.340 46 SHGC:0.49 Orientation:Left Side Window 7:Wood Frame:Double Pane with Low-E 23 0.320 7 SHGC:0.49 Orientation:Left Side Door 6:Solid 21 0.280 6 Orientation:Left Side Door 7:Glass 42 ' 0.320 13 SHGC:0.49 Orientation:Left Side Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 4994 19.0 0.0 235 Furnace 1:Forced Hot Air 93 AFUE Air Cortd'loner 1:Elect' Central Air 18 SEER Complia a Statement he proposed building design described here is consistent with the building plans,specifications,and other ulati s submitted i h t permit application.The proposed building has been designed to meet the 2006 IECC requirements in RES Ve n 4.2 comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Signature Date Project Title:Joyce Residence Report date:05/29/09 Data filename: C:\Program Files\Check\REScheck\Joyce Residence.rck Page 2 of 2 { Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions SE3 4744 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and § 237-1 to § 237'zU Town of Barnstable Code A. General Information Important: Barnstable When filling 1. From: Conservation Commission out forms on the computer, 2. This issuance is for(check one): a. . ® Order of Conditions b. ❑ Amended Order of Conditions use only the tab key to 3. To: Applicant: move your cursor-do not Taylor Joyce use the return a.First Name b.Last Name ke . c.Organization P.O. Box 587 d.Mailing Address Cotuit MA 02630 " e.City/Town f.State g.Zip Code 4. Property Owner(if--different from-applicant): a.First Name b.Last Name 100 Oregon Way LLC �tHE rqy c.Organization P.O. Box 587 �'ALB d.Mailing Address MASS.19. Cotuit MA 02630 t63¢ �0 e.City/Town f.State g.Zip Code 5. Project Location: 100 Oregon Way Cotuit a.Street Address b.Village 016 012 Lot B c.Assessors Map Number d.Assessors Parcel Number f Latitude and Longitude, if known: e.Latitude f.Longitude S Droper-ty-recorded-at-the-Regist-"f-Deeds for(attach additional information if more than one parcel): Barnstable 185911 8502-C2 Lot B a.County b.Certificate Number(if registered land)/Plan/Lot# c. Book d.Page June 6, 2008 July 8,2008 July 23,2008 7. Dates: a.Date Notice of Intent Filed b.Date Public Hearing Closed c.Date of Issuance 8. Final Approved Plans and Other Documents (attach additional plan or document references as needed): Revised Site Plan --------_------------a-Plan Ttle — ---------------------------T------�----_—.__ •' Cape & Islands Engineering David C. Sanicki, P.L.S. b. Prepared By c.Signed and Stamped by July10, 2008 . 1"=20' d. Final Revision Date e.Scale Landscaping Plan, by Michael P. Neath Landscape Construction . 07/02/08 f.Additional Plan or Document Title g.Date wpaforrn5.doc- rev.2/27/08 Barnstable revised 4/11/2008 Page 1 of 10 I Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions SE3- 4744 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and § 237-1.to § 237-14 Town of Barnstable Code B. Findings (cont.) Resource Area Proposed Permitted Proposed Permitted Alteration Alteration Replacement Replacement 7. ❑ Bordering Land Subject to Flooding . a.square feet b.square feet c.square feet d.square feet Cubic Feet Flood Storage e.cubic feet f.cubic feet g.cubic feet h.cubic feet 8. ❑ Isolated Land Subject to Flooding a.square feet b.square feet Cubic Feet Flood Storage c.cubic feet d.cubic feet e.cubic feet f.cubic feet 9. ❑ Riverfront area a.total sq.feet b.total sq.feet Sq ft within 100 ft c.square feet d.square feet e.square feet f.square feet Sq ft between 100-200 ft g,square feet h.square feet i.square feet j.square feet Coastal Resource Area Impacts: Check all that apply below. (For,Approvals Only) 1o. ❑ Designated Port Areas Indicate size under Land Under the Ocean, below 11. ❑ Land Under the Ocean a.square feet b.square feet c.c/y dredged d.c/y dredged 12. ❑ Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes below 13. ❑ Coastal Beaches a.square feet b.square feet c.c/y nourishmt. d.c/y nourishmt. 14. ❑ Coastal Dunes a.square feet b.square feet c.c/y nourishmt. d.c/y nourishmt. 15. ❑ Coastal Banks a.linear feet b.linear feet 16. ❑ Rocky Intertidal Shores a.square feet b.square feet 17. ❑ Salt Marshes a.square feet b.square feet c.square feet d.square feet 18. ❑ Land Under Salt Ponds a.square feet b.square feet c.c/y dredged d.c/y dredged 19, ❑ Land Containing Shellfish a.square feet b.square feet c.square feet d.square feet 20. ❑. Fish Runs Indicate size under Coastal Banks, inland Bank, Land Under the Ocean, and/or inland Land Under Waterbodies and Waterways, above a.c/y dredged b.c/y dredged 21. ❑' Land Subject to Coastal Storm Flowage a.square feet b.square feet wpafonn5.doc- rev.2/27/08 Bamstable revised 4/11/2008 .Page 3 of 10 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions SE3- 4744 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and § 237-1 to § 237-14 Town of Barnstable Code B. Findings 1. Findings pursuant to the Massachusetts Wetlands Protection Act: Following the review of the above-referenced Notice of Intent and based on the information provided in this application and presented at the public hearing, this Commission finds that the areas in which work is proposed.is significant to the following interests of the Wetlands Protection Act. Check all that apply: a. ❑ Public Water Supply b. ❑ Land Containing Shellfish c. ® Prevention of Pollution d. ❑ Private Water Supply e. ❑ Fisheries f. ® Protection of Wildlife Habitat g. ❑ Groundwater Supply h. ® Storm Damage Prevention i. ® Flood Control 2. This Commission hereby finds the project,as proposed, is: (check one of the following boxes) Approved subject to: a. ® the following conditions which are necessary in accordance with the performance standards set forth in the wetlands regulations. This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above,the following General Conditions, and any other special conditions attached to this Order. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent,these conditions shall control. Denied because: b. ❑ the proposed work cannot be conditioned to meet the performance standards set forth in the wetland regulations. Therefore,work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect these interests, and a .final Order of Conditions is issued.A description of the-performance standards which.the proposed work cannot meet is attached to this Order.. c. ❑ the information-submitted by the applicant-is not sufficient to describe the site,-the work, or the effect of the work on the interests identified.in the Wetlands Protection Act. Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and includes measures which are adequate to protect the Act's interests, and a final Order of Conditions is issued.A description of the specific information which is lacking and why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c). Inland Resource Area Impacts: Check all that apply below. (For Approvals Only) 3. ❑ Buffer Zone Impacts: Shortest distance between limit of project disturbance and wetland boundary(if available) a.linear feet Resource Area Proposed Permitted Proposed Permitted Alteration Alteration. Replacement Replacement 4. ® Bank 0 a.linear feet. b.linear feet c.linear feet d.linear feet 5. ® Bordering Vegetated 0 Wetland a.square feet b.square feet c.square feet d.square feet 6. ❑ Land Under Waterbodies a.square feet b.square feet c.square feet d.square feet and Waterways e.c/y dredged f.c/y dredged wpaform5.doc• rev.2/27/08 Barnstable revised 4/11/2008 Page 2 of 10 Massachusetts Department of Environmental Protection MassDEP File Number: Bureau of Resource Protection Wetlands WPA Form 5 - Order of Conditions SE3- 4744 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and § 237-1 to § 237-14 Town of Barnstable Code C. General Conditions Under Massachusetts Wetlands Protection Act (only applicable to approved projects) 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. I 4. The work authorized hereunder shall be completed within three years from the date of thi Oc er , unless either of the following apply: ��' a. the work is a maintenance dredging project as provided for in the Act; or b. the time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance. If this Order is intended to be valid for more than three years,the extension date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse, rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe,tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. 7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of.Deeds.or the Land Court for.the._district in which the,land is located,within the chain of title of the affected property. In the case of recorded land,the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of the registered land,the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. The recording information shall be submitted to this Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry'of Deeds, prior to the commencement of work. 9. A sign shall be displayed at the site not less then two square feet or more than three square feet in size bearing the words, "Massachusetts Department of Environmental Protection"for, "MassDEP"] "File Number SE3-4744 " wpaform5.doc• rev.2/27/08 Bamstable revised 4/11/2008 Page 4 of 10 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions SE3- 4744 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and § 237-1 to § 237-14 Town of Barnstable Code C. General Conditions Under Massachusetts Wetlands Protection Act 10. Where the Department of Environmental Protection is requested to issue a Superseding Order,the Conservation Commission shall be a party to all agency proceedings and hearings before MassDEP. 11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of Compliance (WPA Form 8A)to the Conservation Commission. 12. The work shall conform to the plans and special conditions referenced in this order. 13. Any change to the plans identified in Condition#12 above shall require the applicant to inquire of the Conservation.Commission in writing whether the change is significant enough to require the filing of a new Notice of Intent. 14. The Agent or members of the Conservation Commission and the Department of Environmental Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this Order, and may require the submittal of any data deemed necessary by the Conservation Commission or Department for that evaluation. 15. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and to any contractor or other person performing work conditioned by this Order.. 16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in_place, the wetland boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission. 17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means.At no time shall sediments be deposited in a wetland or water body. During construction, the applicant or his/her designee shall inspect the erosion controls on a daily basis and shall.rernove accumulated sediments as needed. The applicant shall immediately control any erosion problems that occur at the site and shall also immediately notify the Conservation Commission,which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary Sedimentation rbarriers shall serve as the limit of work unless another limit of work line has been approved by this Order. 18. The work associated with this Order is (i)❑ is not(2)❑ subject to the Massachusetts Stormwater Policy Standards. If the work is subject to the Stormwater Policy, the following conditions apply to this work and are incorporated into this Order: a) No work, including site preparation, land disturbance, construction and redevelopment, shall commence unless and until the construction-period pollution prevention and erosion and sedimentation control plan required by Stormwater Standard 8 is approved in writing by the issuing authority. Until the site is fully stabilized, construction period erosion, sedimentation and pollution control measures and best management practices (BMPs) shall be implemented in accordance with the construction period pollution prevention and erosion and sedimentation control plan, and if applicable,the Stormwater Pollution Plan required by the National Discharge Elimination System Construction General Permit. wpaform5.doc- rev.2/27/08 Barnstable revised 4/112008 Page 5 of 10 i LLIMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP Fite Number: WPA Form 5 - Order of Conditions SE3- 4744 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and § 237-1 to § 237-14 Town of Barnstable Code C. General Conditions Under Massachusetts Wetlands Protection Act (cont.) b) No stormwater runoff may be discharged to the post-construction stormwater BMPs until written approval is received from the issuing authority. To request written approval,the following must be submitted: illicit discharge compliance statement required by Stormwater Standard 10 and as-built plans signed and stamped by a registered professional engineer certifying the site is fully stabilized; all construction period stormwater BMPs and any illicit discharges to the stormwater management system have been removed; and all post-construction stormwater BMPs were installed in accordance with the plans (including all planting plans) approved by the issuing authority, and have been inspected to ensure they are not damaged and will function properly. c) Prior to requesting a Certificate of Compliance, the responsible party(defined in General Condition 18(e))shall submit to the issuing authority an Operation and Maintenance (0 & M) Compliance Statement for the Stormwater BMPs.This Statement shall identify the responsible party for implementing the Operation and Maintenance Plan and also state that: 1. "Future responsible parties shall be notified in writing of their continuing legal responsibility to operate and maintain the stormwater management BMPs and implement the Pollution Prevention Plan; and 2. The Operation and Maintenance Plan for the stormwater BMPs is complete and will be implemented upon receipt of the Certificate." d) Post-construction pollution prevention and source control shali be implemented in accordance with the long-term pollution prevention plan section of the approved Stormwater Report and, if applicable, the Stormwater Pollution Prevention Plan required by the National Discharge Elimination System Multi-Sector General Permit. e) Unless and until another party accepts responsibility,the issuing authority shall presume that the responsible party for maintaining each BMP is the landowner of the property on which the BMP is located. To overcome this presumption,the landowner of the property must submit to the issuing authority a legally binding agreement acceptable to the issuing authority evidencing that another entity has accepted responsibility for maintaining the BMP, and that the proposed responsible party shall be treated as a permittee for purposes of implementing the requirements of Conditions 18(0 through 18(k)with respect to that BMP. Any failure of the proposed responsible party to implement the requirements.of Conditions 18(f)through 1.8(k)with respect to that BMP shall be,a violation of the Order of Conditions or Certificate of Compliance. In the case of stormwater BMPs that are serving more than one lot,the legally binding agreement shall also identify the lots that will be serviced by the stormwater BMPs. A plan.and easement deed that_grants the responsible party access to.perform the required operation and maintenance must be submitted along with the legally binding agreement. 0 The responsible party shall operate and maintain all stormwater BMPs in accordance with the design plans,the Operation and Maintenance Plan section of the approved Stormwater Report, and the Massachusetts Stormwater Handbook. g) The responsible party shall: 1. Maintain an operation and maintenance log for the last three years including inspections, repairs, replacement and disposal (for disposal the log shall indicate the type of material and the disposal location); 2. Make this log available to MassDEP and the Conservation Commission upon request; and 3. Allow members and agents of the MassDEP and the Conservation Commission to enter and inspect the premises to evaluate and ensure that the responsible party complies with the Operation and Maintenance requirements for each BMP set forth in the Operations and Maintenance Plan approved by the issuing authority. h) All sediments or other contaminants removed from stormwater BMPs shall be disposed of in accordance with all applicable federal, state, and local laws and regulations. i) Illicit discharges to the stormwater management system as defined in 310 CMR 10.04 are prohibited. wpaform5.doc• rev.2127/08 Bamstable revised 4/11/2008 Page 6 of 10 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions SE3- 4744 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and § 237-1 to § 237-14 Town of Barnstable Code C. General Conditions Under Massachusetts Wetlands Protection Act (cont.) j) The stormwater management system approved in the Final Order of Conditions shall not be changed without the prior written approval of the issuing authority. Areas designated as qualifying pervious areas for purpose of the Low Impact Site Design Credit shall not be altered without the prior written approval of the issuing authority. k) Access for maintenance of stormwater BMPs shall not be obstructed or blocked. Any fencing constructed around stormwater BMPs shall include access gates. Fence(s)shall be at least six inches above grade to allow for wildlife passage. Special Conditions (if you need more space for additional conditions, please attach a text document): D. Findings Under.Municipal Wetlands Bylaw or Ordinance 1. Is a municipal wetlands bylaw or ordinance applicable? ® Yes ❑ No 2. The Barnstable hereby finds(check one that applies): Conservation Commission a. ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal ordinance or bylaw specifically: §237-1 to§237-14 Town of Barnstable Code 1.Municipal Ordinance or Bylaw 2.Citation Therefore,work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to.meet these standards, and a final Order of Conditions is issued. b. ® that the following additional conditions are necessary to comply with a municipal ordinance or bylaw: §237-1 to§237-14 Town of Barnstable Code 1.Municipal Ordinance or Bylaw 2.Citation I The Commission orders that all work shall be performed in accordance with the following conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the conditions shall control. The special conditions relating to municipal ordinance or bylaw are as follows(if you need more space for additional conditions, attach a text document): See pp. 7.1, 7.2, and 7.3 wpaform5.doc.rev.2127/08 Barnstable revised 4/11/2008 Page 7 of 10 SE3-4744 Name: Taylor Joyce Approved Plan= July 10,2008 Revised Site Plan by David Charles Sanicki,P.L.S., and July 2, 2008 Landscaping Plan by Michael P. Neath Co. Special Conditions of Approval I. Preface Caution:Failure to comply with all Conditions of this Order of Conditions can have serious consequences. The consequence may include issuance of a stop work order,fines,requirement to remove unpermitted structures,requirement to re-landscape to original condition,inability to obtain a certificate of compliance, and more. The General Conditions of this Order begin on page 4 and continue on pages 5,6,and 7. The Special Conditions are contained on pages 7.1,7.2 and 7.3 if necessary. All conditions require your compliance. H. Prior to the start of work,the following conditions shall be satisfied: 1. Within one month of receipt of this Order of Conditions and prior to the commencement of any work approved herein,General Condition number 8(recording requirement)on page 4 shall be complied with. 2. It is the responsibility of the applicant,the owner and/or successor(s)and the project contractors to ensure that all conditions of this Order are complied with. The applicant shall provide copies of the Order of Conditions and approved plans(and any approved revisions thereof)to project contractors prior to the start of work. Barnstable Conservation Commission Forms A and B shall be completed and returned to the Commission prior to the start of work. 3. General Condition 9 on page 4(sign requirement)shall be complied with. 4. The Conservation Commission shall receive written notice one(1)week in advance of the start of work. 5. The work limit line shown on the approved plan shall be staked in the field by the project surveyor/engineer. 6. Stake 4sObarles1 acked by trenched-in siltation fencing shall beset along the approved work limit line. Effective sediment controls shall remain until the site is stabilized with vegetation;then shall be removed.. 7. A sequence of color photographs showing the undisturbed buffer zone shall be submitted to the Conservation Commission. Note:the strawbales and siltation fence must show in the foreground p.7.1 (or bottom of the photographs. 8A5meetuig between the;general contractor,property manager,and the Conservation Agent shall take place regarding construction vehicle access and operations. Following the meeting,an agreed upon protocol shall be submitted. III. The following additional conditions shall govern the project once work begins. Note especially Special Condition No. 17, requiring verification of the locations of the foundation and strawbale line. 9. General Conditions No. 12 and No. 13 (changes in plan)on page 5 shall be complied with. 10. General Condition No. 17(maintaining sediment controls)on page 5 shall be complied with. 11. The work limit shown on the approved plan shall be strictly observed. 12. There shall be no construction disturbance of the site below(on the wetlands side of)the work limit. 13. The Conservation Commission,its employees,and its agents shall have aright of entry to inspect for compliance with the provisions of this Order of Conditions. 14. Unless extended,this permit is valid until JUL 2 3 2011 Trees shall not be removed on the pond side of the driveway without advance consultation with,and approval of,the Conservation Agent. �� protocol f constructi'on vehicle access and operation shall be adhered to. The general contractor shall report back to the Conservation Commission every month,at end of month,regarding compliance. £�hu1�7sUopnxjbnplhoefndtion,the project surveyor or engineer shall verify in writing or by plan to �Rarrect location of the foundation and work limit line and note any discrepancies from a the approved plan. If Lerif cation is in the form of an as'-built plan,the plan provided shall be drawn at the same scale as the approved plan. - �t°� 18. The driveway shall be constructed of perviousmatenal(gravel or shell)or alternate as approved by the Conservation Commission. 9. uring construction,no area shall be left unmulched or unvegetated for more than 30 days.All areas disturbed during construction shall be revegetated immediately following completion of work at the site. Mulching shall not serve as a substitute for the requirement to revegetate disturbed areas at the conclusion of work. 20. All new lawn areas shall be underlain with a minimum of six(6)inches of loam. 21. Herbicide,pesticide and fertilizer use is discouraged on lawns within Conservation Commission jurisdiction. If fertilizer must be used,only slow-release low-nitrogen(with 30-50%water insoluble p.7.2 nitrogen or`W.I.N') and low-phosphorus fertilizers shall be applied. Over-fertilizing shall be avoided (not-to-exceed limit= 1 pound of nitrogen per 1,000 sq.ft. of lawn per application). Ensure that no fertilizer is spread on hard surfaces like driveways and sidewalks. 22 Work hrmt markers(wood stakes)shall remain{untilCertficate of Compliance is issued for this project. IV. After all work is completed,the following condition shall be promptly met: 23. At the completion of work,or by the expiration of this Order,the applicant shall request in writing a Certificate of Compliance for the work herein permitted. Barnstable Conservation Commission Form C shall be completed and returned with the request for a Certificate of Compliance. Where a project has been completed in accordance with plans stamped by a registered professional engineer,architect,landscape architect or land surveyor,a written statement by such a professional person certifying substantial compliance with the plans and setting forth what deviation,if any,exists with the record plans approved in the Order shall accompany the request for a Certificate of Compliance.At the time of the request for a Certificate of Compliance,an updated sequence of color photographs of the undisturbed buffer zone shall be also submitted. In addition,the efficacy of the proposed rain gardens shall be reported on. p.7.3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions SE3- 4744 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and § 237-1 to § 237-14 Town of Barnstable Code E. Issuance This Order is valid for three years, unless otherwise specified as a special JUL 2 3 2008 condition pursuant to General Conditions#4,from the date of issuance. 1.Date of Issuance Please indicate the number of members who will sign this form: This Order must be signed by a majority of the Conservation Commission. 2.Number of signers The Order must be mailed by certified mail (return receipt requested)or hand delivered to the applicant.A copy also must be mailed or hand delivered at the same time to the appropriate Department of Environmental Protection Regional Office, if not filing electronically, and the property owner, if different from applic Signatures: 01 Notary Acknowledgement Commonwealth of Massachusetts County of Barnstable Y E T On this Day of Month Year oos Before me, the undersigned Notary Public, ��.„,,,,� yka -4 personally appeared Name of Document Signer proved to me through satisfactory evidence of identification,which was/were D6scription of evidencb of identification to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he/she signed it voluntarily for its stated purpose. As member of Barnstable Conservation Commission City[rown Sig nature of Notary Public Printed Name of Notary Public Place notary seal and/or any stamp above 3/a'7/u`i My CommisA's on Expires(Date) This Order is issued to the applicant as follows: ❑ by hand delivery on ® by certified mail, return receipt requested.,on .Illy 9. Date Name Signature Date wpaform5.doc• rev.2/27/08 Barnstable revised 4/11/2008 Page 8 of 10 . w Massachusetts Department of Environmental Protection MassDEP File Number: Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions SE3- 4744 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and § 237-1 to § 237-14 Town of Barnstable Code F. Appeals The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject to this Order, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate MassDEP Regional Office to issue a Superseding Order of Conditions.The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and a completed Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7)within ten business days from the date of issuance of this Order.A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant, if he/she is not the appellant.Any appellants seeking to appeal the Department's Superseding Order associated with this appeal will be required to demonstrate prior participation in the review of this project. Previous participation in the permit proceeding means the submission of written information to the Conservation Commission prior to the close of the public hearing, requesting a Superseding Order or Determination, or providing written information to the Department prior to issuance of a Superseding Order or Determination. The request shall state clearly and concisely the objections to the Order which is being appealed and how the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands Protection Act.(M.G.L. c. 131,.§40), and is inconsistent with the wetlands regulations (310 CMR 10.00). To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. Section G, Recording Information is available on the following page. F wpaform5.doc• rev.2/27/08 Barnstable revised 4/11/2008 Page 9 of 10 I Massachusetts Department of Environmental Protection MassDEP Fite Number: Bureau of Resource Protection - Wetlands WPA i=orm 5 — Order of Conditions sE3- 4744 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and § 237-1 to § 237-14 Town of Barnstable Code G. Recording Information This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in which the land is located,within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land subject to the Order. In the case of registered land, this Order shall also be noted on the Land Court Certificate of Title of the owner of the land subject to the Order of Conditions. The recording information on this page shall be submitted to the Conservation Commission listed below. Bamstable Conservation Commission Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commission. --------------------------------------------------------------------------------------------------------------------------- To: Barnstable Conservation Commission Please be advised that the Order of Conditions for the Project at: 100 Oregon Way, Cotuit, MA 02630 SE3 4744 Project Location MassDEP File Number Has been recorded at the Registry of Deeds of: Barnstable County Book Page for: Property Owner and has been noted in the chain of title of the affected property in: Book Page In accordance with the Order of Conditions issued on: Date If recorded land, the instrument number identifying this transaction is: Instrument Number If registered land, the document number identifying this transaction is: Dov_: 1 7 09 5 F 761• 08-11-21308 u:20 Document Number tY Signature of Applicant wpaform5.doc• rev.2/27/08 Barnstable revised 4/11/2008 Page 10 of 10 I +i- •-er Liber The Ohio Casualty Insurance Company Mutual® 9450 Seward Road,Fairfield,Ohio 45014 Bond# 5052511 BOND KNOW ALL MEN BY THESE PRESENTS: That we E.B.Norris&Son, Inc. - 138 Osterville-West Barnstable Road Osterville,MA 02655 (Full Name[top line]and Address[bottom line]of Principal) (hereinafter called the Principal) as Principal, and The Ohio Casualty Insurance Company with principal offices at Hamilton, Ohio(hereinafter called the Surety)as Surety,are held and firmly bound unto Town of Barnstable 200 Main Street Hyannis,MA 02601 (Full Name[top line]and Address{bottom line]of Obligee) (hereinafter called the Obligee),in the penal sum of One Thousand Four Hundred Dollars&00/100 (Dollars)$ 1,406.00 for the payment of which well and truly to made, we do hereby bind ourselves, our heirs. executors, administrators, successors and assigns,jointly and severally,firmly by these presents. WHEREAS,the Principal has made or is about to make application to the Obligee for a License to Construct a Single Family Home at 100 Oregan Way Cotuit,MA. Project#09-2391. 350 foot frontage. for a term beginning on May 18,2009 _ and ending on* May 18,2010 (*strike out if license or permit is for an indefinite term) NOW,THEREFORE,if the Principal shall indemnify the Obligee against any loss directly arising by reason of failure of said Principal to comply with the laws or ordinances under which said license or permit is granted, or any lawful rules or regulations pertaining thereto, then this obligation shall be void;otherwise to remain in full force and effect. PROVIDED,HOWEVER,AND UPON THE FOLLOWING EXPRESS CONDITIONS: 1. This bond shall be and remain in full force during the term of said license or permit unless canceled in accordance with paragraph 2 below; but if said license or permit was issued for a specific term, and is renewed for one or more specific terms, this bond will be extended to cover such additional term(s) upon the execution by the Surety of a Continuation Certificate, provided such certificate is acceptable to the Obligee. In no event , however, shall the liability of the Surety be cumulative from year to year or from period to period,nor exceed the penal sum written in this first paragraph of this bond. 2. The Surety shall have the right to terminate its liability by notifying the Obligee in writing ten(10)days in advance of its intention to. do so. SIGNED,SEALED AND DATED May 18,2009 E.B.Norris&Son,Inc. By: Principal i The Ohio Casualty Insurance Company ' 1 By: Attorney-in-Fact S-3853 License or Permit Bond (Unnumbered) i •� I Principal: E.23.Norris&Son,Inc. 'POWER OF ATTORNEY POA Number: 40-463 THE OHIO CASUALTY INSURANCE COMPANY Obligee: Town of Barnstable WEST AMERICAN INSURANCE COMPANY Bond Number: 5052511 Know All Men by These Presents:THE OHIO CASUALTY INSURANCE COMPANY,an Ohio Corporation,and WEST AMERICAN INSURANCE COMPANY,an Indiana Corporation pursuant to the authority granted by Article III, Section 9 of the Code of Regulations and By-Laws of The Ohio Casualty Insurance Company and West American Insurance Company do hereby nominate,constitute and appoint:,Mark McCartin,Robert W.Miller,Kelly C.Bolton or Martha A.Kenney of Hyannis,Massachusetts its true and lawful agent (s) and attorney (s)-in-fact, to make, execute, seal and deliver for and on its-behalf as surety,and as its act and deed any and all BONDS, UNDERTAKINGS, and RECOGNIZANCES, not exceeding in any single instance ONE MILLION ($1,000,000.00) DOLLARS, excluding, however, any bond(s) or undertaking(s)guaranteeing the payment of notes and interest thereon. And the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Companies,as fully and amply,to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected officers of the Companies at their administrative offices in Fairfield,Ohio,in their own proper persons. The authority granted hereunder supersedes any previous authority heretofore granted the above named attorney(s)-in-fact. In WITNESS WHEREOF,the undersigned officer of the said The Ohio Casualty Insurance Company and West American Insurance Company has hereunto subscribed his name and affixed the Corporate Seal of each Company this 7th day of January,2008 `SY INS& NINSUlt - a, o tZv✓� SEAL ,b SEAL0. /� Sam Lawrence Assistant Secretary r• .•f STATE OF OHIO, COUNTY OF BUTLER On this 7th day of January,2008 before the subscriber,a Notary Public of the State of Ohio,in and for the County of Butler;duly commissioned and qualified,came Sam Lawrence, Assistant Secretary of The Ohio Casualty Insurance Company and West American Insurance Company,to me personally known to be the individual and officer described in,and who executed the preceding instrument,and he acknowledged the execution of the same,and being by me duly sworn deposes and says that he is the officer of the Companies aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and the said Corporate Seals and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal at the City of Hamilton,State of Ohio,the day and year first above written. AS Notary Public in and for County of Butler,State of Ohio sA My Commission expires August 5,2012 This power of attomey is granted under and by authority of Article III,Section 9 of the Code of Regulations and By-Laws of The Ohio Casualty Insurance Company and West American Insurance Company,extracts from which read: Article III,Section 9. Appointment of Attomeys-in-Fact. The Chairman of the Board,the President,any Vice-President,the Secretary or any Assistant Secretary of the corporation shall be and is hereby vested with full power and authority to appoint attorneys-in-fact for the purpose of signing the name of the corporation as surety to,and to execute,attach the seal of the corporation to,acknowledge and deliver any and all bonds,recognizances,stipulations,undertakings or other instruments of suretyship and policies of insurance to be given in favor of any individual,firm,corporation,partnership,limited liability company or other entity,or the official representative thereof,or to any county or state,or any official board or boards of any county or state,or the United States of America or any agency thereof,or to any other political subdivision thereof This instrument is signed and sealed as authorized by the following resolution adopted by the Boards of Directors of the Companies on October 21,2004: RESOLVED,That the signature of any officer of the Company authorized under Article III,Section 9 of its Code of Regulations and By-laws and the Company seal may be affixed by facsimile to any power of attorney or copy thereof issued on behalf of the Company to make,execute,seal and deliver for and on its behalf as surety any and all bonds, undertakings or other written obligations in the nature thereof;to prescribe their respective duties and the respective limits of their authority;and to revoke any such appointment. Such signatures and seal are hereby adopted,by the Company as original signatures and seal and shall,with respect to.any bond,undertaking or other written obligations in the nature thereof to which it is attached,be valid and binding upon the Company with the same force and effect as though manually affixed. s 1,the undersigned Assistant Secretary of The Ohio Casualty Insurance Company,American Fire and Casualty Company and West American Insurance Company,do hereby;°. certify that the foregoing power of attorney,the referenced By-Laws of the Companies and the above resolution of their Boards of Directors are true`and correct copies and are in, full force and effect on this date. _ IN WITNESS WHEREOF,1 have hereunto set my hand and the seals of the Companies this 18 day of May 2Q09 W' P`tY INSp 0...... SEAL ,b SEAL �i t. W, ; Mark E.Schmidt Assistant Secretary II New Page 1 Page 1 of 1 W TOWN OF BARNSTABLE LOCATION /00 e2jkl 4141 SEWAGE# 20-M-Jn VILLAGE 44AII ASSESSOR'S MAP&1 0/44-49/2 INSTALLERS NAME dt PHONE NO. SEPTIC TANK CAPACM i)w G ,i a av ed -AcsD C 4 O,- LEAcKNG FACILITY:(type) Pod E (size) 0 r0!X,r r NO.OF BEDROOMS BUILDER O OWNER PERMITDATE: COMPLIANCE DATE: 2 Separation Distance Between the: f Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S Feet Private Water Supply Well and Leaching Facility. (lf any wells exist on siti or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) //� Feet Furnished byLL,wre • • i vOrCh � 40, � ti O /jai✓ / Ihttp://www.town.bamstable.ma.tis/assessing/2009/HMdisplay.asp?mappal=016012&seq=1 5/6/2009 2 i natfonaignu July 7, 2009 Attn: Bob Maglio @ E.B.Norris Re: 100 Oregon Way Cotuit. Ma 02635 This letter is to notify you that the gas service located at 100 Oregon Way in Cotuit, Ma was cut off at the gate box on 6/25/2009 If you have any questions, please feel free to contact me @ 781-907-2921. Regards, Celeste Murphy National Grid Customer Driven Construction 40 Sylvan Rd -E2 Waltham, Ma 02451 781-907-2921-t6l# _ 781-522-1056-fax# O 1I?f$ OF it X-re Pistrict * COTUIT + C'_ Urpartnunt * FIRE DISTRICT vo 1926 9,a 4300 FALMOUTH ROAD, P.O. BOX 451 �ATFoJULI COTUIT, MASS. 02635 PHONE 508-428-2687 FAX 508-428-7517 i June 12,2009 EB Norris& Son, Inc. ,. 138 Osterville/West Barnstable Road Osterville,MA 02655 ATT: Craig Ashworth,President Dear Craig, The water has been turned off at the street and the meter has been disconnected at 100 Oregon Way. Please contact us a couple of days before the demolition so we can meet with the contractor to remove water service materials from the site. -Sincerely, Chris Wiseman Superintendent 7814418765 NSTAR SUM SW3161 10:53:57 a.m. 06-26-2009 1 !1 -AR Dcctlic&Gas C'unpary Onc NSlAR Way Wcwa d,MassaC iUSOM',020u0-9230L EL Fq rALfC.GAS June 26, 2009 Taylor& Barry Joyce PO Box 2012 Cotuit MA 02635 RE: 100 Oregon Way Cotuit Dear Taylor& Barry Joyce: This letter will serve as confirmation that the electric service at 100 Oregon Way Cotuit, has been removed as of 06/25/09----w/o# 1717523. Based on this information, there is no electric power to this building and you may proceed with the demolition. If you have any questions, please contact me at(781) 441-x3797 Sincerely, Ms Hebshie New Connections Office 0)0/)=NewTemplate �,HEr, 'own of Barnstable Y e Regulatory Services BARNSTA;� Thomas F. Geiler,Director Building Division -Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnsta b le.ma.us -Office: 508-862-403 8 r Fax: 508-790-6230 PLAN REVIEW ' Owner: .T yTcllr_ Map/Parcel: Project Address/V6'mKC16vW er Builder: /�/6;W�57 The following items were noted on reviewing: - l qsir- /5 /1W l_oo.D zwe /Z/- &9 S_rlf L fv)\ /zr use ,66E, ,0 u0u- r -7(fo CtU R 40.E �L.�dq-7'/d-7�/,f olE fI�'/�'IZd�/E� �`tac� /Jc�NTi�CJ� 7j'o Cdfk/ZC��6ol� e e_APA)oT GSCGE � ,3P� E�'l �� K1 ,�/ f f'i°,2ox -To re cr. Reviewed by: Dater Q:FMTI.S:Plnrvw C�����£ ��_ _ 1 i �tNlS�� •k uy ' ',U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires March 31,2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION Forinsurance Company Use: Al. Building Owners Name 100 Oregon Way,LLC Policy Number.;.".-., A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number 100 Oregon Way City Cotuit State MA ZIP Code 02635 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Carriage house, assessors map 16 parcel 12 A4. Building Use(e.g.,Residential,Non-Residential,Add ition,.Accessory,etc.)Residentia garage/carriage housel. A5. Latdude/Longitude: Lat. Long. Horizontal Datum: ❑ NAD 1927 ❑ NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance: AT Building Diagram Number 1A A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) sq ft a) Square footage of attached garage 616 sq ft -b) No.of permanent flood openings in the crawlspace or b) '-No.of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade 4 c) Total net area of flood openings in A8.b• sq in <oc) Total net area of flood openings in A9.b 800 sq in d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings?. ❑ Yes ❑ No SECTION B-'FLOOD INSURANCE,RATE MAP (FIRM) INFORMATION 81. NFIP Community Name&Community Number B2.County Name B3.State Barnstable Barnstable MA B4. Map/Panel Number 65.Suffix B6.FIRM Index B7.FIRM Panel B8. Flood B9. Base Flood Elevation(s)(Zone 250001 0022D Date Effective/Revised Date Zone(s) AO, use base flood depth) 7/2/92 - - 7/2/92 All - 11 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑'Other(Describe) " 811. Indicate elevation datum used for BFE in Item B9:. ® NGVD 1929 ❑ NAVD 1988 ❑ Other,(Describe) B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(CPA)?-,!, "❑ Yes ®,No - -- Designation Date ❑ CBRS ❑-OPA SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' '® Finished Construction `A new Elevation Certificate will be required when construction of the building is complete.' . C2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,Vl-V30,V(with BFE),AR,AR/A,AR/AE,AR/Al-A30,AR/AH,AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item AT Use a the same datum as the BFE. Benchmark Utilized Vertical Datum Conversion/Comments Check the measurement used. a) Top of bottom floor(including basement,crawispace,or enclosure floor) ❑feet ❑meters(Puerto Rico only) b) Top of the next higher floor. 19 .10 ®feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) ❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) 10 .1 ®feet ❑1 meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 19 .10 ®feet . • El (Puerto Rico only) (Describe type of equipment and location in Comments)' 0 Lowest adjacent(finished)grade next to building(LAG) 9 '.5 ®feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 9 9 ®feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including: 9 -.5'•' ; ®feet -[]'Meters(Puerto Rico only) structural support SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation v information. 1 certify that the information on this Certificate represents my best efforts 10 interpret the data available:/ r.l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,,Section 1001.[1 `��OF MA Check here if comments are provided on,back of form Were latitude and longitude in Section A provided by a �,y1� gCyG - _ licensed land surveyor?. ❑ Yes' ❑ No DAVIo N . Certfier's Name David Sanicki License Number 28085 CHARLES. SANICXI Title owner Company Name Cape&Islands Engineering 28085 ' Address 800 Falmouth Road,Suite 3Q1C City Mashpee State MA ZIP Code 02649 FIST �srOpgL LAM Signature -;! *" Date 3/25/10 Telephone 508-477-7272 FEMA Form,81-31, Mar 09 See reverse side for continuation. Replaces all previous editions a t EANISTADSLE . t i IMPOKrANT: In these spaces,copy the corresponding information from Section A For Insurance Company Use: Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number 100 Oregon Way City CotuitState MA ZIP Code 02635 Company NAIC Number SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED). Copy both sides of this Elevation Certificate for(1)community official,(2)'insurance agent/company,and(3)building owner.' Comments The detached garage/carriage house slab is elev 10.1. The pressure treated sill is elev 11.1 - 4 smart vents(200Sq incherehch for a total of 800 Sq inches)were installed in the detached garage/carriage house. Signature Date 3/25/10 ❑ Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items El-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. For Items E1-E4, use natural grade,if available. Check the measurement used. In Puerto Rico only,enter meters. Ell. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). ( a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is ° ❑feet ❑meters .❑above or.❑below the HAG. E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet' ❑meters ❑above or❑'below the HAG. E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION " The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sections A,B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address city State . ZIP Code Signature Date Telephone Comments ` ❑Check here if attachments SECTION G-COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B,C(or E), and G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8 and G9. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.❑ The following information(Items G4-G9)-is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued a G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for. ❑New Construction El Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters(PR)Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum G10.Community's design flood elevation ❑feet ;❑meters(PR)Datum' Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments: FEMA Form 81-31,War 09 " Replaces all previous editions ,w „ TOWN OF BARNSTABLE c i ,i F Building Photographs Continuation Page For Insurance Company Use: Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number 100 Oregon Way City Cotuit State MA ZIP Code 02635 Company NAIC Number If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." Y ate .,. x _ Front Y g1„T1R-6�-- Side TOWN OF F J" STI,SLE 'A fir) -2 Pit 3: 29 Building Photographs See Instructions for Item A6. For Insurance Company Use: Building Street Address(including Apt, Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number 100 Oregon Way City Cotuit State MA ZIP Code 02635 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructions for Item A6. Identify all photographs with: date taken-, "Front View" and "Rear View"-, and, if required, "Right Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page, following. 7, — c Rear Ir i Side TO"IN OF TA5LE APR _2 p? 3. 29 4 j.. ---- .. -� ;kf � n wnd�ei' con �oh U.�-.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency I Expires March 31,2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION Forinsurance:Company;Use: Al. Building Owner's Name 100 Oregon Way,LLC Policy Number A2. Building Street Address(including Apt., Unit,Suite,and/or-Bldg.No.)or P.O.Route and Box No. Company.NAIC Number 100 Oregon Way City Cotuit State MA ZIP Code 02635• ~ A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) - Carriage house, assessors map 16 parcel 12 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude:Lat. - Long. I I Horizontal Datum: ❑ NAD 1927 ❑ NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT Building Diagram Number 2 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) sq ft a) Square footage of attached garage sq ft b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade c) Totgi t areb-of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in d) Eng%ered I'Vod openingf? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No to SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION to � EI B1.NFIP Court unity]Tame&Corhmunity Number 62.County Name TB3.State Barnstable - Barnstable MA B4.Map/P 1 Nurn er BS.IIS.uffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 25 R1 � 0 u.21 Date Effective/Revised Date Zone(s) AO,use base flood depth) 7/2/92 7/2/92zat All 11 B10. Indicatee soi� a>Fd E of the Ba olevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile I@ FIRM ❑ Community Determined ❑ Other(Describe) B11. Indicate elevation datum used for BFE in Item 69: ® NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe) B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ® No Designation Date . " ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ® Building Under Construction* ❑ Finished Construction -- - *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1430,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item AT Use the same datum as the BFE. Benchmark Utilized Vertical Datum Conversion/Comments Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor) ❑feet ❑meters(Puerto Rico only) b) Top of the next higher floor 19 .10 ®feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) ❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) 10 .1 ®feet ❑meters(Puerto Rice only) e) Lowest elevation of machinery or equipment servicing the building 19 .10 ®feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 9 .5 ®feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 9 .9 ®feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or'stairs,including 9 .5 ®feet ❑meters(Puerto Rico only) structural support SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. /certify that the information on this Certificate represents my best efforts to interpret the data available.1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001.❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a �0� Of y licensed land surveyor? ❑ Yes ❑ No DAVID G Certfier s Name David Sanicki License Number 28085 c C1 AA- � SANICK', y Title owner Company Name Cape&Islands Engineering 2808 Address 800 Falmouth Road,Suite 30T6 City Mashpee State MA ZIP Code 02649 -/STER�� ' Signature Date 9/15/09 Telephone 508d77-7272 `�ONAI LANDS FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions r _ cJ IAFPORTANT: In these spaces,copy the corresponding information from Section A. Fob Insurance Company,use: Building Street Address(including Apt,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number 100 Oregon Way _ City CotuitState MA ZIP Code 02635 CompanyNAIC;iVumber. SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments Signature Date 9/15/09 ❑ Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. For Items El-E4,use natural grade,if available. Check the measurement used. In Puerto Rico only,enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑below the HAG. b)Top of bottorRpor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Bui f g Diagrams 6-9 permanent flood openings provided in Section A Items 8 and/or 9(seepages 8-9 of Instructions),the next higher floor (elevati2.bihe diagra s)of the building is ❑feet ❑meters ❑above or ❑below the HAG. E3. Attachearage.(top of slab) s Elfeet ❑meters Elabove or Elbelow the HAG. E4. Top of orm Jknachinery ind/or equipment servicing the building is ❑feet E]meters ❑above or[Ibelow the HAG. E5. Zone AO�ronly: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinanc& 0-As ❑ No I EF Unknown. The local official must certify this information in Section G. 3 CJ SECTI NO-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property er ortbIner s autht n`ad representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE) orZoneAOrrasigrftre. The staents in Sections A,B,and E are correct to the best of my knowledge. Property Ownb7s or v6`riv er's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E), and G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8 and G9. G1.❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.❑ The following information(Items G4-G9)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for. ❑New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters(PR)Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum G10.Community's design flood elevation ❑feet ❑meters(PR)Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 81-31, Mar 09 , ` Replaces all previous editions Building Photographs See Instructions for Item A6. For Insurance Company Use: Building Street Address(including Apt, Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number 100 Oregon Way City Mashpee State MA ZIP Code 02649 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructions for Item A6. Identify all photographs with: date taken-, "Front View" and "Rear View", and, if required, "Right Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page, following. �► — \ + _ 4 _ r E `O r T'1 O N t7o CJ) _ � M Building Photographs Continuation Page For Insurance Company Use: Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number 100 Oregon Way City Mashpee State MA ZIP Code 02649 Company NAIC Number If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken-, "Front View' and "Rear View", and, if required, "Right Side View" and "Left Side View." ti T " ti rY�iRFEr- _ - _ ,�.��-yy � w/ s ^� �L'r Ili. - -•_��' _ �:e �. _ 4 TOWN OF BARNSTABLE 2(09 SEP 24 Ali 48 bivisl �• o$1 / NOTE:P.T.SILL ELEV.11.1 / 1SC S°I �. ti�o� �O� i i tk i "I certify that thefoundation shown on 0 a PLOT PLAN OF LAND this plan is as it actually exists on the °,°°a°°° LOCATED IN ground and that it conforms to the town of COTUIT,MAS S. Barnstable zoning regulations regarding DAVID ° PREPARED FOR yards backs." o SANICi i o E.B.NORRIS,BLDRS.. C' 0 28085 DATE:SEPT.9,2009 SCALE: 1"=40' date.Sept.9,2009 CAPE & ISLANDS ENGINEERING floodzoneABEL.11 MASHPEE,MASS. P rho r;¢s Page 1 of 2 Date: October 04,2007 Case No.:07-01-1148A LOMA �4a �F� a _ T Federal Emergency Management Agency x Washington,D.C.20472 ' LETTER OF MAP AMENDMENT . DETERMINATION DOCUMENT REMOVAL COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF BARNSTABLE, Lot B, as shown on the Plan of Land recorded as Plan No. 8502-C2; BARNSTABLE COUNTY, in the Office of the Register of Deeds, Barnstable County, COMMUNITY MASSACHUSETTS Massachusetts,•(TM:016;TL:012) ` 4 i COMMUNITY NO.:250001 AFFECTED NUMBER:2500010022D MAP PANELY DATE:7/211992 FLOODING SOURCE:NANTUCKET SOUND APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:41.558, -70.445 SOURCE OF LAT&LONG:PRECISION MAPPING STREETS 7.0 DATUM:NAD 83 DETERMINATION OUTCOME `1%o ANNUAL ,LOWEST LOWEST BLOCK/ WHAT IS CHANCE ADJACENT LOT SECTION LOT SUBDIVISION STREET REMOVED FROM FLOOD FLOOD GRADE ELEVATION THE'SFHA ZONE ELEVATION ELEVATION (NGVD 29) NGVD 29) (NGVD 29 B -- — 100 Oregon Way Structure B 11.0 feet 11.3 feet - Special Flood Hazard Area (SFHA) - The SFHA is an area that would be inundated by the flood having a 1-percent chance of.being equaled or exceeded in any given year base flood). - ADDITIONAL CONSIDERATIONS Please refer to the appropriate section on Attachment 1 for the additional considerations listed below. PORTIONS REMAIN IN THE SFHA This document provides the Federal Emergency Management Agency's determination regarding a.request for a.Letter of Map.Amendment for the property described above. Using the information submitted and the effective National Flood Insurance Program (NFIP) map, we have determined that the structure(s) on the'property(ies) Ware not located'in the SFHA, an area inundated by the flood having a 1-percent chance of x, being equaled or exceeded in any given year (base flood). This document amends the effective NFIP map to remove the subject property from the SFHA located on the effective NFIP map; therefore,..the'Federal mandatory flood insurance,requirement does not apply. However, the lender has the option to continue the flood insurance requirement to protect its financial risk on the. loan. A Preferred Risk Policy (PRP) is available for buildings located outside the SFHA. Information about the PRP and how one can apply is enclosed.' This determination is based on the flood data presently available. The enclosed documents'provide additional'information regarding this determination. If you have any questions about this document, please contact the FEMA Map Assistance Center toll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, 3601 Eisenhower Avenue, Suite 130, Alexandria, VA 22304-6439. William R.Blanton Jr.,CFM,Chief Engineering Management Section Mitigation Directorate ' 1 Page 2 of 2 Date: October 04,2007 Case No.:07-01-1148A, LOMA Federal Emergency.Management Agency. Washington,D.C.20472 LETTER'OF MAP AMENDMENT DETERMINATION DOCUMENT (REMOVAL) ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS) ' PORTIONS OF THE PROPERTY REMAIN IN THE SFHA(This Additional Consideration applies to the preceding 1 Property.) Portions of this property, but not the subject of the Determination/Comment document, may remain in the Special Flood Hazard Area. Therefore, any future construction or substantial improvement on the property remains_ subject to Federal, State/Commonwealth, and local regulations for floodplain management. r , This attachment provides additional information regarding this request. If you have any questions about this attachment,,please contact the FEMA Map Assistance Center toll free at (877) 336-2627(877=FEMA MAP) or by letter addressed to the Fed eraf Emergency Management ' Agency,3601 Eisenhower Avenue,Suite 130,Alexandria,VA 22304-6439. William R.Blanton Jr.,CFM,Chief Engineering Management Section .. Mitigation Directorate Q�yyAR�^,yF - °� wFederal Emergency Management A enc t 4 Washington,, D.C. 20472 �t9NDSEGJ e g October 04,2007 MS.GRETCHEN REILLY -CASE NO.:07-01-1148A 100 OREGON WAY COMMUNITY: TOWN OF BARNSTABLE, a ` COTUIT,MA 02635 BARNSTABLE COUNTY, MASSACHUSETTS. COMMUNITY NOZ 250001 DEAR MS.REILLY: This is in reference to a request that the Federal Emergency Management .Agency',(FEMA) determine if the property described in the enclosed document is located within an identified Special Flood Hazard Area, the area that would be inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year (base flood), on the effective National'Flood Insurance.Program(NFIP) map. Using the information submitted and the..effective NFIP'map, our determination is shown on the attached Letter of Map Amendment (LOMA) Determination Document. This determination document provides additional information regarding `the "effective NFIP'map, the legal description of, the property and our determination. Additional documents are enclosed which provide information regarding the subject property and LOMAs. Please see the List of Enclosures below to determine which documents are enclosed:' Other attachments specific to this request may be included as referenced in the .Determination/Comment document. If you have any questions about this'letter or any of the enclosures,,.please contact the'"_ a , FEMA Map Assistance Center toll free at (877) .336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, 3601.Eisenhower'Avenue, Suite 130, Alexandria, VA 22304-6439. Sincerely; William R.Blanton Jr.,CFM,Chief Engineering Management Section` Mitigation Directorate LIST OF ENCLOSURES: LOMA DETERMINATION DOCUMENT(REMOVAL) cc: State/Commonwealth NFIP Coordinator Community Map Repository Region Mr.David Sanicki I %� � � � a � _ �� � �� P � - ��° ? � � , �� p`oFTHE,ow�� Town of Barnstable BARNSTARLE. ' Regulatory Services f6S9 Building Division ,erFO MAC a, 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type-of Inspectis� )✓creation- Permit Number .Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: ?offs (' JtJ ,e A/C J� Please call: 508-862-46 f8 for re-inspecti n. Inspected by Date 6 -7 0 DAVID O : KNUTTUNE.N , P. E . Structural Engineer TOWN OFEA ' ' STAE.r E January 07, 2010 Mr. Robert McKechnie,Building Inspector Town of Barnstable BUding Division 200 Main Street Hyannis,MA,02601 RE: Carriage House at Joyce Residence 100 Oregon Way; Cotuit MA Permit#B20091224 1 Dear Sir: This letter is to certify that: 1. My design of the Carriage House at the Joyce Residence, 100 Oregon Way,in Cotuit, as documented in Structural Drawings S-1 thru S-11 (and in particular S-8), dated 23 March 2009, conforms to the relevant structural provisions of the Massachusetts State Building Code, 780 CMR, 71h Ed.;.and that, 2. I have made three site visits during construction to observe the installed structural elements, and have also reviewed comments and photos` from construction observations made by the Architect, K. Marshall Works of.Archi-Tech Associates, Inc. of Cotuit MA, and that,based on those site visits and other observations, 3. To the best of my knowledge and belief, the referenced structural work is in accordance with my structural design and the above-cited Code provisions. Very truly yours, David O. Knuttunen,P. E. �,a FS°rOhA� ` Mass. Reg. No. 32306 � 4 CC: K. Marshall Works (ATA), Craig Ashworth (E.B. Norris) 24 BRIDGE ST NEWTON, MASSACHUSETTS 02458-1125 phone: (617)558-5853 fax: (617) 558-5803 email: dok@dokpe.com - world wide web: http://dokpc.com Y'" wiD DAVID O . KNUTTUNEN , P. E . Structural Engineer TOWN OF Z�l JAR, I ! Alf January 07, 2010 Mr. Robert McKechnie,Building Inspector Divl ® I Town of Barnstable Building Division 200 Main Street Hyannis,MA 02601 ' RE: Carriage House at Joyce Residence 100 Oregon Way, Cotuit MA Permit#B20091224 Dear Sir: : This letter is to certify that: 1. My design of the Carriage House at the Joyce Residence, 100 Oregon Way,in Cotuit, as documented in Structural Drawings S-1 thru S-11 (and in particular S-8), dated 23 March 2009, conforms to the relevant structural provisions of the Massachusetts State Building Code, 780 CMR, 7th Ed., and that, 2. I have made three site visits during,construction to observe the installed structural elements, and have also reviewed comments and photos from construction observations made by the Architect, K. Marshall Works of Archi-Tech Associates, Inc. of Cotuit MA, and that,based on those site visits and other observations, 3. To the best of my knowledge and".belief, the referenced structural work is in accordance with my structural design and the above-cited Code provisions. a.. `vTery truly yours, - c Z. 0 cy 10 David O. Knuttunen,P. E. �fiFss„�NA�-`���` Mass. Reg. No. 32306 CC: K. Marshall Works (ATA), Craig Ashworth (E.B. Norris) 24 BRIDGE ST NEWTON, MASSACHUSETTS 02458-1125 phone: (617)558-5853 fax: (617) 558-5803 • email: dok@dokpe.com world wide web: http://dokpe.com >, � IV 4 r INE Tp Town of Barnstable _ BARNSTABLE. » Regulatory Services Y MASS. 1639• Building Division prFO MPS A. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice b� Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. J�The following items need correcting: ,r✓ GX7'97—S i h O✓ Please call: 508-862-46-38�for re-inspecti n. Inspected by `//� C Date 6 -7 A 0 �a ^> TOWN OF BARNSTABLE.BUILDING PERMIT APPLICATION Map- Parcel A lication #cv pp // Health Division Date Issued r 7 l� Conservation Division L Application Fee Planning Dept. Permit Fee �5 713 Date Definitive Plan Approved by Planning Board , Historic - OKH _ Preservation/ Hyannis Project Street dress Village Owner Address Telephone ' Permit Request zgA F oil IF T " _h .9f.fig,14 F 11'X, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new' Zoning District Flood Plain Groundwater Overlay Project Valuation iYo;6M .ADConstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new ._-+ C-D co Number of Bedrooms: existing _new Total Room Count (not inc uding baths): existing new First Floor Roo Count'' Heat Type and F el: Gas ❑Oil ❑ Electric ❑ Other Central Air: Yes ❑ No Fireplaces: Existing New Existing wood/coal stove❑A ❑ No_--� Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑.pew '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) 4 4 Name Telephone Number c.-ie �1�~ ' C Address License #�� 117 / G Home Improvemen Contractor# -� Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �� ' FOR OFFICIAL USE ONLY ,APPLICATION# `r pATE ISSUED; i ' MAP/PARCEL N0. •-- r r G . 1 1 ADDRESS ` `VILLAGE OWNER DATE OF INSPECTION: - LA'FOUNDATION�v ,ir ,l,* R4- #RklY ,. LB '4 •FRAME INSULATION.: FIREPLACE , ELECTRICAL: ROUGH FINAL , r f PLUMBING: ROUGH FINAL P GAS: ROUGH FINAL FINAL BUILDING_ = - I DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations • 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): t Address: City/State/Zip: ®Phone#: Are,you an employer?Che"th. opriate box: I Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' insurance,. 9. []-Building addition [No workers'comp.i comp.P• required.] 5. ❑ We are a corporation and its ' 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. ' right of exemption per MGL Y �o workers comp. 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. ntractors 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 thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: — s/i-hY Job Site Address: City/State/Zip:d4Y41t Attach a copy of the workers'com nsation cy declar on page(showing the policy number and expiration date). Failure to secure coverage as required under S ction 25A of on c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi der a pains and e , flies o erjury that the information provided above ' e and correct Si afore: Z Date: Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority.(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ' Contact Person: Phone#: I Town of.Barnstable - - Reguiator-y Services . RLAM1Cea&RTyy �+ss Thomas F.Gefier,Director, j Buildin ,.. . =•� . g Division Tom Perry,Building Commissioner 200 Main Street,,Hyannis,MA 02601 , .a www.town.barnst able-ma.us Office: 508-862-4038 - Fax 508-790=6230 i _ ,_ _ Property-Owner Must_ Complete and Sign This Section 7-7___._ --If Using;A Builder. ® , as Owner Of the subject property a hereby arize - ,: to act r µ c an my behal� in 0 zna tiers relatrve yto work a �rued by this BE'�cliug p==t � r—.. r ..."-.'•�e1 - Vie. _. __ `. J£ y.. ;Y -i• � LL r �.r _ ..�.� r ", .- .. _ ».. ., L - s of Job)" **Pool fences and alarms•are;the responsibility of the applicant. Pools 4_ _< are not to be filled or`utilized-before.fence'is�,�installed`and-all final• y =w inspections are perfomaed and accepted. - S f f Print N e . • Date y .^ Q:FORMS:OWNWERMiSMI,?OOLS&2012 f Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supcn isor License: CS-066147 CRAIG J RILEY PO BOX 382 OSTERVIII WA 0 J.•G.� „ n+`' Expirat' Commissioner 02/05/2015 ,per ,7i�e �oom�xaouuea o�✓�aaaawFuae�ld �\ Office of Consumer Affairs&B�ufsiness Regulation License or registration valid for individul use only HOME IMPROY-EME#MCQNTRACTOR before the expiration date. If found return to: Registrati 125799 Type: Office of Consumer Affairs and Business Regulation Expiratio : -1%3W2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 WC. . ILEY` BUILDEw, W.C 4 CRAIG RILEY, � r 10 B VVIANNO AVE." R 3 F'j OSTERVILLE, MA02655.'-:.. -:," Underse----- ry N a' thout signet THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) m A LI DATA -7 client#I: 10798 aRILEYCJ CE RTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/Y" !E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ;CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED rlATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. • nIT:If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed."SUBROGATION IS WAIVED,subject to ;s and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the �rtte holder In Ileu of such endoreement(s). TA �/Inu A O'Neil Jfance Agency PHONE a� No Eft:508775 A� No: 5087781 a18 lyannough Rd., PO Box 1990 E-MAIL ADDRESS: Innis' MA 02601 INSURER(S)AFFORDING COVERAGE NAIL it ZED INSURERA:Natlonal Grange Mutual Insuranc i C.J. Riley Guilder,Inc. INSURER B: P.0. Box 382 INSURER C: Osterville,MA 02655 INSURERD: INSURER E: ERAGES INSURER F CERTIFICATE NUMBER- REVISION S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED NUMBER: B THE POLICY PERIOD gTIFICA NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS �TIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, :LUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.TYPE OF INSURANCE DDL 8 LIC p GENERAL LIABILITY INSR WVD POLICY NUMBER IOy PO EFF MP059664 uMrrs X COMMERCIAL GENERAL LIABILITY 5IO2R013 05/02/201 EACH HG0 CURgqR��ENCE $1 000 000 CLAIMS-MADE OCCUR PREMISES Eaocu""ce $500000 MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1 OW 000 'EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 000,000 POLICY JECT PRO LOC PRODUCTS-Co P/OP AGG s2,000 00O 7"MOSILE LIABRITY M9059664 $ �O 5/02R0M 05v02t201 OMBBIINdE�DtSINOLE LIMIT 1 AUTOS ED X AUTOS BODILY BODILY INJURY(Per person) $ X AUTOS X NON-0WNED BODILY INJURY(Per accident) $ AUTOS PR �ERTY�MDAMAGE It X UMBRELLA UAB X OCCUR SINDER359107 $ EXCESS LIAB CLAIMS-MADE 541212013 05412M01 EACH OCCURRENCE $3 000 000 OED RETENTION$ _. AGGREGATE $3 0O0 ORKERS COMPENSATION $ 10 EMPLOYERS'LIABLny WC059664 5J0 13 OS/05/701 X STATU OTH IYPROPRIETORMARTNER/EXECUTIVE YIN FICER/MEMBER EXCLUDED? ® N/A andatory In NHI E.L. H ACCIDENT $500 000 d under S EA EMPLOYEE - 00 000 CRIPTION IPTION OF OPERATIONS below E. ISEASE- E.L.DISEASE-POLICY LIMIT $500 000 "ION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD It".Additional Remarks Schodul%N more space le requlred) ince coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Ig contained in the certificate of Insurance shall be deemed to have altered,waived,or extended the tge provided by the policy provisions. 1CATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN • �annis, MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE op 25(2010(05) ©1988-201U ACORD CORPORATION.All rights re se ed i110879/M110878 of 1 The ACORD name and logo are registered marks of ACORD 1 t LS1 *.7e- a7t 5113)10 Lawn 0- 0 septic r O � CE Table f 4'-O 2 Deck Grill septic 2 Bar septic 000 Lawn IO 2 ° Screened Porch Not Tub ° Gristmill Patio ° Tabl-- i irelulac�e ° howe ° .f `Fool Utilitie ° O. Deck APPENDIX G the barrier shall be 2 inches (51 mm) measured on the - 2. a gate and barrier shall have no opening larger (!, side of the barrier which faces away from the swimming than 1/2 inch (12.7 mm) within 18 inches (457 pool.Where the top of the pool structure is above grade, mm)of the release mechanism. such as an above-ground pool, the barrier may be at 9, Where a wall of a dwelling serves as part of the barrier, ground level,such as the pool structure,or mounted on one of the following conditions shall be met: top of the pool structure.Where the barrier is mounted on top of the pool structure,the maximum vertical clearance 9.1.The pool shall be equipped with a powered safety between the top of the pool structure and the bottom of cover in compliance with ASTM F 1346;or the barrier shall be 4 inches(102 mm). 9.2.Doors with direct access to the pool through that 2. Openings in the barrier shall not allow passage of a wall shall be equipped with an alarm which pro- 4-inch-diameter(102 mm)sphere. duces an audible warning when the door and/or, 3. Solid barriers which do not have openings, such as a shall its screen,if present,are opened.The alarm sha be listed and labeled in accordance with U masonry or stone wall,shall not contain indentations or protrusions except for normal.construction tolerances 2017. The deactivation switch(es) shall be and tooled masonry joints. located at least 54 inches (1372 mm) above the threshold of the door;or 4. Where the barrier is composed of horizontal and vertical members and the distance between the tops of the hori- . 9.3. Other means of protection, such as self-closing zontal members is less than 45 inches (1143 mm), the doors with self-latching devices, which are horizontal members shall be located on the swimming approved by the governing body,shall be accept- pool side of the fence. Spacing between vertical mem- able as long as the degree of protection afforded is not less than the protection afforded by Item bers shall not exceed 13/4 inches (44 mm) in width. Where there are decorative cutouts within vertical mem- bers, spacing within the cutouts shall not exceed 13/4 10. Where an above-ground pool structure is used as a bar- inches(44 mm)in width. rier or where the barrier is mounted on top of the pool 5. Where the barrier is composed of horizontal and vertical structure,and the means of access is a ladder or steps: members and the distance between the tops of the hori- 10.1. The-ladder or steps shall be capable of being zontal members is 45 inches(1143 mm)or more,spacing. secured,locked or removed to prevent access; between vertical members shall not exceed 4 inches(102 or ! mm).Where there are decorative cutouts within vertical members,spacing within the cutouts shall not exceed 13/4 10.2. The ladder or steps shall be surrounded by a Sec- inches mm)in width. barrier which meets the requirements of Sec- tion AG105.2,Items 1 through 9.When the lad- . 6. Maximum mesh size for chain link fences shall be a der or steps are secured,locked or removed,any 21/4-inch(57 mm) square unless the fence has slats fas- opening created shall not allow the passage of a tened at the top or the bottom which reduce the openings 4-inch-diameter(102 mm)sphere. to not more than 13/4 inches(44 mm). AG105.3 Indoor swimming pool. Walls surrounding an 7. Where the barrier is composed of diagonal members,. indoor swimming pool shall comply with Section AG105.2, such as a lattice fence,the maximum opening formed by Item 9. the diagonal members shall not be more than 13/4 inches. ' (44 mm). AG105.4 Prohibited locations. Barriers shall be located to 8. Access gates shall comply with the requirements of Sec- Prohibit permanent structures, equipment or. similar objects tion AG105.2,Items 1 through 7,and shall be equipped from being used to climb them. to accommodate a locking device. Pedestrian access AG105.5 Barrier exce:'hoes Spas o of tubs with a safety gates shall open outward away from the pool and shall be cover which complies with ASTM F 1346 s listed in Section self-closingand have a self-latching device.Gates other AG107,shall be exem o�m e p or vrsrons of this appendix. P than pedestrian access gates shall have a self-latching device.Where the release mechanism of the self-latch- ing device is located less than 54 inches(1372 mm)from the bottom of the gate,the release mechanism and open- ings shall comply with the following: ENTRAPMENT PROTECTION FOR SWIMMING 8.1. The release mechanism shall be located on the POOL AND SPA SUCTION OUTLETS pool side of the gate at least 3 inches (76 mm) AG106.1 General. Suction outlets shall be designed and below the top of the gate;and installed in accordance with ANSI/APSP-7. 792. 2009 INTERNATIONAL RESIDENTIAL CODE® 06/20/2013 08:33 19786838288 ROBERT BENT 15064 P. 001/009 To", : k f ` 1410 7, djards CSC Spa Covers and the A,S.T.M. .44 MERLIN INDUSTRIES, INC. This letter certifies t when properly installed,using all . IS'R hardware provided for such installation, CSC Standard, Deluxe and Ultra Professional Spa Covers meet or exceed the standards set forth by The American Society of Testing and Materials in %OVA A.S.T.M. F1346-91 titled "Standard Performance Specification for Safety Covers and Labeling Requirements for All Covers for Swimming Pools, Spas and Hot Tubs". J V Exceptions to the above statement include but are not limited M :o 1- No hold down straps. 2- Standard or Deluxe covers larger than 108" along the hinge. 3- Improperly Installed covers. 4- Covers using flat foam cores. Any covers not able to be designed in such a way as to guarantee that the A.S.T.M. standard be met,require a liability waiver signed by the dealer purchasing the cover. This waiver form is to inform the dealer and homeowmr that the standards may not be met as installed. It-is Merlin Industries, Inc. position that said purchasing dealer should also require the signature of the homeowner on the waiver forni in such instances. Merlin Industries, Inc. will not be held responsible or liable for improper installation of covets designed to.meet the A.S.T.M F1346-91. Merlin Industries, Inc. will not be held responsible or liable for remakes or duplications of covers originally not designed to meet the A.S.T.MF1346-91. Rev 8.5.2010 MERLIN INDUSTRIES,INC. 28O4 Bast ante=not Wonslon,Nsmllton,NJ 08618 (800)280-1836 FAX(000)2091, i81 www.mmdinlndustrlos.com 06/20/2013 08:33 18788638288 ROBERT BENT #5084 P. 002/009 SPA C6VM:*': l rr Available for Download at www.merlinindustries.com Top Quality in Five choices Custom Spa Covers offers a professional cover solution for every spa owners needs. Whether you have a standard make and model, or a custom designed in-ground masterpiece, Custom Spa Covers has your cover! .gib. ;:. Quality and affordability, our Economy cover features a tapered 1 lb. density EPS foam core, sealed in a 4 mil. vapor wrap. The Economy cover 1 Year comes with two locking buckles and 4 handles. The Economy cover is Limited Warranty J available in Russet (Brown). The foam core is braced with a galvanized steel c-channel at the hinge for added strength. A 3" skirt is standard, .:. Not your everyday spa cover, our Standard cover features a tapered 2 lb. density foam core, sealed in a 4 mil. vapor wrap. The Standard cover comes with four locking buckles and four handles. The Standard cover is 2 Year w available in eleven colors! The foam core is braced with a galvanized Limited Warranty steel c-channel at the hinge for added strength.A 3" skirt is standard. The Standard cover features a two-year limited warranty. The Standard cover meets or exceeds all A.S.T.M. safety standards. Added strength and durability make our Deluxe cover a great value. The Deluxe cover takes all of the features of the Standard cover adds 3 Year _;;J a 6 mil, vapor wrap and fiberglass reinforced strapping on one-foot centers. The Deluxe cover is available in your choice of eleven colors! Limited Warranty The Deluxe cover features a three-year limited warranty. The Deluxe cover meets or exceeds all A.S.T.M safety standards. ,,:yT.�_�..,. ..ate,.,.,..._................ As tough as it gets, our fiberglass reinforced plastic (FRP) cover is made for heavy snow loads or larger spas that need -A the added security of the strongest cover available, On the=:;��.:a ?• �': :;�.� � 5 Year outside the Ultra cover has all the great looks of all of our spa covers. On the inside the Ultra cover's foam inserts are Limited Warranty sandwiched between two layers of fiberglass reinforced plastic for unsurpassed strength. The Ultra cover features a five-year limited warranty. The Ultra cover meets or exceeds all A.S.T.M. safety standards. 9 Every spa needs a cover to keep in heat and keep out debris. For larger or free- form in ground spas where regular foam spa covers can be too heavy or cannot be installed,the Custom spa cover team brings you our Thermo-light floating 5 Year 1 spa cover. Using the finest marine grade vinyl and a special foam core, your Thermo-light cover is made to last and will not absorb water. A special large Limited weave mesh bottom insures the cover"skin"will not hold water. Thermo-Light Warranty dimensions should be water's edge, not cabinet or acrylic measurements. Thermo-light covers do not meet A.S.T.M safety standards. Thermo-light covers are not designed to support weight. • Due to the added weight of the fiberglass reinforced plastic sheets on our Ultra foam, we do not put straps on Ultra covers over 96"because if incorrectly used as handles they will tear. For covers not receiving straps,you must order a hold-down kit in order to meet A.S.T.M. Safety Standards. Please specify what type of material (concrete, wood,etc.)the hold down straps will anchor into. 36 • Covers over 108" may require liability waivers. 06/20/2013 08:33 18786638288 ROBERT BENT #5064 P. 003/009 t>t mIgnation:F 1340—81 (Reapproved 2003) Standard Performance Specification for Safety Covers and Labeling Requirements for All Covers for Swimming Pools, Spas and Hot Tubs' Thin sean4aam it iswod wader the 0104 dosianadnn F 1346.ebc number immedwaly PeUawing the desigusion IndlOW the year of oslOW adcAan or,in ON case of rwieton,the YOU of hat rcvisioo.A number in pamnbasea ht4hxtu0 the year of laws reapptuval.A auprmeript Milon(6)ituiicates an pdharid chop since the tact revision or w9proval. i. Scope 3.1.2 automatic rover--a cover which can be placed over I.I This specification establishes requiremcats for safety the water are$ and removed with a motorized mechanism Covers for sw"muming pools,spas,hot tubs,and wading pools actuated by a suitable control mechanism.. See also power (hereiWer referred to As pools, unless otherwise speeif:ed). safely cover(PSC),other cover(QC). When eomaxly installed and used in accordance with the 3.1.3 barrier—something that restrains or obstructs access manufacdutir'a instructiom% this specihcatiou is intended 10 to the body of water. reduce the risk of drowning by inhibiting the access of children 3.1.4 blanket—a material used for thermal insulation. Sao under live years of age to the water, also solar energy blorrkel. 1.2 This specification includes performance tests to demon- 3.1.5 sower--something that covers,protects or shelters,or strate the compliance or noueompliaace to requirements herein a combination thereof,a swimming pool,spa,or hot tub. stated for safety covers.Tt also includes marking requirements 3.1.6 debris rowi—a cover with attendant appurtenanocs for all covers, positioned over the pool area which permits the Cover to 1.3 The values stated in imch-pound stets arc to be regarded pnvem debris,such as foliage,dirt,windblown trash,seed the as the standard. The values in parentheses are given for like from entering the pool. It is intended to be completely information only, removed before the entry or bathers. Sere also other covers 1.4 1%@ following safety hazards caveg pertains only to the (0Q. test meth08s section, Section 9, of this specitic4tiou: M9 3.1.7 decks—those areas abutting a pool,spa,or hot tub that standard does»or pu4Vrf to address all of the s*ty concerns, are specifically constructed or installer!(for example,of wood, Vmw.associated with its use.It is the rursponsihility of the user concrete, brick, stone, and the like) for use by bathers for of this standard to establish appropriare safely and health sitting, standing or walking and my-also act as a base for practices and deWmi to the applicability of regulatory limits- supports for covets, dons prior to use. 3.1.8 dome--a semipermanent enclosure supported by tMae3s, or positive air pressure erected over the pool arcs to 2. RK+felroatad Documents provide temperature and atm08pheric control over the pool 2.1 07A Document: environment. National Slcctrical Code,Attiele 680.2e 3.1.9 eneW conservation• qhe reduction of heat loss from 3. Termato pool water through air convection or evaporative cooling, or both. 3.1 Defaritiom of rents Spe effx to This StonldW.. 3,1.10 but tuba spa constructed of wood with sides and 3.1.1 appurienratces--subordiaato parts or adjunct sacs. bottoms formed separately; and the whole sbw joined W My coulpanents to the cover such as hardware including gtfr by pressure from surrounding hoops,bands or rods;as buckles, swaps, tics, sprhtgs. anchors, tracks. rollers, lit'ting distinct from spa units f red of plastic,concrete, metal, or Arens,sad the lure. other materials. 3.1.11 intaecerrih7e locations"•••a location at least 5 R (1.5 m)above the ground with no other access such as hand or 'This spwifi mion is under the!tp'"gion or A57M cammiaae F13 on footholds which would permit a child to reach the location. Camuma PMUM Ares is dw 4anct responsibility of Sybooraw4 t o F15.23 an 3.1.l2 manual cover—-a Cover which p C-0 for Ponta,snag,and Nor Tuba requires it to be laced Cmm# edidae 91)rove4 Fab. 10, 20M, Published May 21109. Originally over the water area by hand. Sex also mammal safely cover approved In 1991.brat previous odiden approval to 1996 to F 13*.91(19%), (MSC),and Other covert(OC). a Available from Na40nal rise Trowica Assoc.,Baaemnamb Turk.Nincy. MA 02269. Cop,npntOAsnt M*nanmwe.100 Bear itatoaro ma.PO wee Cyoo.wwr COnelloewdran.PA townaasa.united shoes. 06/20/2013 08:34 19786838288 ROBERT BENT #5064 P. 004/009 F 1948—91 (21303) 33.13 markings--the application of numbers, letters, la- 4. Cover Classiffeadons and Minimum Qualification bels. tags, symbols or colors to provide identification and Criteria ' safety information and to expedite handling during shipment 4.1 Power Safety Cover(PSG}--Provides a high level,of and storage. safety for children under the age of Ave by inhibiting their 3.1.14 manual safety cover. (MSC)—s barrier which re- access to the water. quires it to be placed over the water manually.Provides a high 4.1.1 Must satisfy 5.1.5.3, 6.1-6.5, 7.1-1.4, 8.1. 8.2, 8.4- level of safety for children under the age of Ave by inhibiting 8.12,9.1.9.4, 10.1-10.4.aid all subsections. their access to the wear. 4.2 Manual Scifety Cover(i&Q---Provides a high level of 3.1.15 other,covers (OC)—includes any cover type not safety for children under the age of five by inhibiting their incorporated in the other two classifications;PSC,MSC.They Scars to the water•MAY require a longer period of time to be are not intended to serve as a barrier for children under the age fully secured. of five. 4.2.1 Must satisfy 5.1.5.3, 6.1-6.5. 7.1-7.4, 9.1, 8.2, 8.4- 3.1.16 Power safety cover(PSG 8.12,9.1-9.4,and all subsections. Po f removed barrier which can ed 4.3 Oth er Covers(OC)—Includes any cover type not incor- placed over the water area and removed with a motorized posted in the other two categories MSC,PSC.They are not mechanism actuated by a suitable control mecbanssm.Provides intended to serve as a barrier far children under the age of five. a high level of safety for obfldten under the age of five by Design characteristics may be hazardous when used in the Whiting their access to the water. presence of children under the'age of five. 3.1.17 safety cover--a barrier(intended to be completely 4.3.1 Shall satisfy 5.1.5.3,8.J-8.3,8.5-8.12,and all subscc- removed before entry of bathers),for swimming pools,spas, tions. hot tubs or wading pools, attendant appurtenances and/or anchoring mechanisms which reduces—when property )a- S. Materials and Manufacture bcicd,installed,used and maintained in accordance with the 5.1 Only materials not known to be harmful to health, ntanufactatrers'published instructions--tbe risk of drowning of within the intended application,shall be used. childnm under five years of age,by inhibiting their access to 5.2 All materials and components shall be durable and the Contained body of water,and by providing for the removal satisfactory for the intended purpose under the conditions of any substantially bazardous level of collected surface water. normally prevailing at the site. See also power safety cmr(PSG),and manual v*ty cover 5.3 The cover shall be mariufaetured or fabricated,or both, in accordance with geaerally accepted, good manufacturing 3.1.18 solar energy blankeis—a cover which is a floating practices, translucent(not transparent)heat insulating sheet incorporat- ing,for example,encapsulated air bubbles or similar low heat 6. General Requirements for Safety Covets transfer(floating) sheet material whose purpose is to inhibit 6.1 InstalladoWUse of sgfttty covers Unless iastalled by hest dissipation from the pool,water surface through air the manufacturer, or responsible parties, or both, detailed owtvectioa or evaporative cooling.7h*sheet material,custom- instructions for installation shall be given in a form included in WHY translucent(not transparent)to permit the transfer of solar the packaging or a label,or both,attached to the cover. radiation energy directly to the pool water at all depths and 6.2 Labels attached to the cover shall meta the general intended for day and night use,is cut to the shape of the pool l requirements described in 8.5.1 and 8.8-9.8.2. and is not aZxed to the pool structure, It is intended to be 6.3 Markings for safety covers shall include: completely removed before the patty of bathers. 6.3.1 the manufacturer's name, 3.1.19 energy conservation blanket-a cover which is a 6.3.2 date manufactured or installed,and Roaring beat ittsulAting sheet material incorporating, for ex- 6.3.3 instructions to consumers to inspect the cover For ample, a cellular foam or similar low-heat transfer material premature wear or deterioration. whose purpose is to inhibit but loss ftom the covered water, 6.3.4 Labels attached to covers shall meet the general through air convection or evaporative cooling,or both. Such requirements desorbed in 8.4.1,8.7-8.8.1.and 8.9. materials arc customarily cut to the shape of the pool and are 6.4 Fastening mechaabrmy or devised—nrs, attachment intended for a night covering.The blanket is not affixed to the, points,anchors,anchorage,alai controls for automatic Coven pool structure.It is intended to be completely removed before or other means of fastening a cover shall include provisions the entry of bathers. such as keys, combination locks, special tools, devices, or 3.1.20 wading Pool-a shallow pool intended for wading, inaoeessible locations, and the like, to inhibit children under not swimming. five years of age from removing or operating the cover.When 3.1.21 waterline---the waterline shall be defined in one of subjected to the load and perimeter deflection tests described in the following ways: 9.1=4 92,All lastcning devices shall remain in their intended, secured or closed,or both,position.After the tast,the intended 3,122 skimmer system—the water line shall be at the performance of the device should not be impaired. raid-point of the operating range of the skimmers. 6.5 Openings--The cover shall be designed in such a way 3.1.23 ove0bw.rystem—the waterline shall be at the top of that,when it is tested by the test method described in 9.4,any the overflow outlet. opening in the major component or between the edge of the 08/20/2013 08:34 18786638288 ROBERT BENT #5064 P. 005/008 F 1344—91 (2003) cover and the deck surface or coping wall,or both,and the top private label distributors), or both. Labels attached to covers surface of the spa or pool does not allow the test object to pass shall meet the general requirements described in 8.5.1 and through The test object shall not gain access to the water,or be 8.6-8.8.2. subject to entrapment. 8.2 Warning 7.aboli—All covens aba11 be required to have 6.6 Scams.tics or welds in the cover shall show no signs of attached the following warning labo4 damage,which will impair intended performance of die device 9.2.1 Signal Word--WAIiJV'ING, when the cover is tested by the methods described in 9.1-9.4. 6,22 SafeotAlen Slanhol—Preceding the signal word there 7. ftdormamce Regldremenla for Safety Covers ' shall be triangle with an exclamation point inside the triangle. 11.2.2.1 Word Message—The standard word message Shan 7.1 Static Load-ln the case of a pool with a width or be AVOID DROWNING RISK which shall be dw-firm mrs- diameter greater rhea 8 t3(2.4 m)from the periphery,the cover sago to appear directly under the signal word. shall be able to!told a weight of 485 lb(220.0 kg)(2 adults and 9.2.2.2 Additional Warr!Message Slalement—Covers with 1 child)to permit a rescue operation, any of the outlined hoards in Fig. 1 shall list all applicable 7.1.1 In the cast of a pool with a width or diameter not wig statements on the label, greater than 8 ft(2.4 m)the cover shall withstand the weight of 8,3 Color -safety cover warning label. 2751b(1 et kg)(weight of a child and d adult). in 9.1.ianee 8.3.1 Signal Word--Black letters with orange background. shaA be determined by the rest method described d designed 8.3.2 Sgfwy Alen S,ymba�-Black triangle with orange ex- such Perimeter Deflection—'�'he cover gaoll be designed in olantation paint. such a way titer,when 4 is tested by the teat method describe! in 9,2,deflection of tite cover does not allow the test object to 8.3.3 Bard Me-y-yu —Black lettering on white backgrouud pass between the cover and the side of the pool, or to gain or white letters-on black background. access 10 the water. 84 61or�—Safety cover warning label. 7.3 Surface Draimige—The cover shall be so constructed, 8.4.1 Colors assigned to the signal word panel may also be or incorporate is system,or have an auxiliary system provided, used for the message word panel provided the panel colors that when used in accordance with the manufacturer's instruc• contrast with the lettering of the label. This is applicable to Lions,shall drain substantially all standing water from the cover covers conforming with the PSC and MSC classifications only, within a period of 30 min after cessation of normal rainN. 8.5 Warnhig labeti-Letter size. Compliance shall be determined by the test in 9.3, 8.$.1 Lettering shall be of a size that ambles a parson with 7.4 Opeakg Am,—Thc tests shall be conducted by the test normal vision, including corrected vision,to read the!safety method described in 9.4 to demonstrate that any opening in the sign or label at a safe viewing distance from the hazard. major component or between the edge of the cover and the Considerations should be given to environmental variables that deck surface or coping wall,or both,and the top surface of the will affect readability. pool or tie top surface of the spa is sutflclently small and 8.5.2 Signal Word—Letter height shall be at least 50% strong to prevent the opening from being forced to a size that greater than the selected height of the message panel wording, will allow the test object to pass through. 8.5.3 Sq ety Alert Symbut--Safety alert symbol,when =ad P. Mdnlmtun i.abfd Regttiremeats for All Covers far with the signal word shall precede the signal word.The bast of the styand skn symbol shall be on the same horizontal line as the base of the letters of the signal word. The height of the 9.1 Product Lahel—All covers shall be labelod/mruked to safety alert symbol shall equal or exceed the signal word letter identify manufacturers or other responsible parties (such as height, _ 'NAZAP"ARNING STATEMENT CHART' 9 This Hamm!:slab: Add This Mniing Swolnsnl: `Weil not auppart welpht fan defined In sin ap docwwn)Nonsewred or •Slay off aver—v*not support weroht.. rmptoparly seared covers 'Cometrimt by*Ping under cover 'Kddp chlldron away.Children or obieda cannot be seen under aver. *00m4no an l tap of court In ammulatsd surface water lag datino In this •Remove Standing Watsr-�Ild can drawn on lop of*over. 'Cwrosalmany Entrapment—Oossal under aver •RanroVe oevar(e)completely hafdre entry of bea+er9-antrepment po"No. Vowel requirement for a4 covers 'Non•ndurod or Improporly soared aovms am a h=rd. -Opllon to 0"ra'13811141y Coven 'Failure to'lolk w on m au4ons may roardt in iniury or drowning. 'Cover does not Most all feg1.1lfemela6 of this spodir"Uon for PSG,MSG 'This Is not a Safely Cover. Firl.1 Mica►inia rntrtp ismonNnt Cho" 06/20/2013 08:34 18786638288 ROBERT BENT #5064 P. 006/009 F 1348-01 (2003) 8.5.4 Word message lento height shall be as defined in Table described in 8.2-BA.3 shall be placed on the printed side of the ► package intended for display and/or consumer information. 8.6 Letter,ttytet The label shall be printed on or affixed to the package and not 8.6.1 Signal Word ahull be in sans serif letters in upper case easily removable, only. 9.11.1 When special ch=mstanoes limit use of label colors 8.6.2 Message Panel shall be in sans serif letters, Lepers, to two colors,the colors assigned to the signal word panel tray may be in upper case only also be used for the message ward panel provided that the 8,6.3 Examples of acceptable lettering styles are: medium panel colors contrast with background color of packaging. or bald helvotica,or news gothic bold, 8.12 Compliance Labeling—All labels shall note the spe- 8.7 Plaawm—Location shall be such that the message cifie cover classificadon. will: 8.7.1 Be readily visible to the intended viewer,taking into 9. '!rest Methods For Safety Covers consideration all possible viewing angles,and 9.1 Static Load Tat,, 8.7.2 Alert the viewer to the potential hazard in time to take 9.1.1 This test shalt be conducted to demonstraw that the appropriate action, cover is capable of supporting a weight of (a) 485 lbs 8.7.3 label mast be located so as net to be removed in the (composed of one 214-kb,one 225-lb or one 50-lb weight)for fitting process. pools•ear spas within a width or diameter greater than 8 ft at(b) 9.9 Life Expectancy—Tbe label shall have a reasonable 27S lbs(composed of one 225-lb and one 50-lb weight)for a expected life with good color stability and word message pool or it spa with a width or diameter equal to or less than 8 legibility when viewed as stated in B.5.1.Reasonable expect- A distributed over I. ft each, all of which are within a 3-ft ancy sball be taken into uonsideration in accordance with the radius without the test objects causing damage which would expected life of the product allow any of the test objects to pass through the cover.During 8.8.1 Protection...-Who possible, placement of label this test there shall be no requirement for the absence of water should provide protection from foreseeable damage,fading,or appearing on the surface of the cover, visual obstruction caused by abrasion. ultraviolet light or 9.1,2 Procedure..-The pool shall be filled to its waterline substaaxa such as chemicals or din. and the cover fitted in accordance with the cover manuf ictur- S." Attachment-The label shall be attached permanently er's instructions.The test objects shall be placed on the surface to the product or so that it cannot be easily removed. of the cover at the following critical points: 8.9 Replacement•--Prctduct/Warning !abets should be rc- 9.1.2.1 The center point of the cover. plaeecl,by the product user when they no longer meet legibility 9.1.2.2 Between attachment points and a distance of at least requirements for safe viewing distance described in 8.5.1 and 4 ft(1.2 m)but not to exceed 6 ft frost the side of the pool. 8.7.1.1n cases where products have an extensive expoctod life 9.1.2.3 The test objects shall remain in each test position for or where exposed to extreme conditions, the product user a period of 5 min. should be able to obtain replacomeat labels from the manufac- 91 Perimeter Deflection Teat: rarer or responsible party. 9.2.1 Tibia test shall be conducted to damonstrate the fol- 9.10 Imir cction/Use Labe!Any product'instructions or lowing,if a child under the age of five were to fall onto the use label not attached to the product,intended to be viewed by cover neither that child nor another child could slip tbroughh the corwumer/user shall contain in its contents the some any openings that may occur between the cover and the side of applicable warning label as set forth in 8.24.6.3. the pool. 8,10.1 Who special circumstances limit use of label colors 9.2.2 Perimeter Dejlcatlan Test Object--Test object shall be to two colors,the colon assigned to the message word panel 3.7 in.(0.09 m)by 5.7 in.(0.14 m)by a minimum 12 in.length may also be used for the signal word panel provided that the and a weight of 36.6 lbs in an ellipsoidal shape.Soo Fig.2. panel colors contrast with background color of instruction/uso 9.2.3 Procedure--With 50 lbs(22.7 kg)on the cover at a label distance of at]cast 4%but not exceeding 6 ft from the aide of 9.11 Packaging Label--If packaging is intended for product the peal,the saute covet shall not deQoct to allow a perimeter display to the consumer/user, applicable warning label as test object to pass through, gain access to the water or be subject to enrtrapmeat between the cover and the side of the TA13I.B t Ward Massage Letmr Haight Sim pool 80 r ttnlmum t. W ROt ht ter minimum letter rtstshi tar• 9,3 Surface Drainage Tart: DOW= FAVORAMA RaWkv uNFAVORAW RoWN 9.3.1 Surface Drainage Tevt nbjeo—Timmy'or equivalent 0andMoes Condillons (32 in, length by 9 in. width by 5 in. deep by 36.6 lbs torso-shaped object) shall be placed on the pool cover in a I=14pn 24In. HeAahl on.) a vi"— �'m"D"-- rrotaht(in.) � vim Dig supine position,facoup,within two to three feet of and parallel View 01"nos VWv Dist with the pool's edge.Three minutes latex there shall not be an 2410 as h moot 0111 %W_ '+s18ht On.) � __ ,_ unsafa amount of water.An unsafe amount of water is defined Nagnt ern,) W Vow Di>seana Helpht(N.1 , view plat gleslar chat ss U, -'"'311t� a'erimmy"is a CPR mwoyuln,alrm yw old boy;avalloble A",Crawl ids toe,P.D.Sox 807,Dixon Avoi a,WN,4;wk,NY 12489. 06/20/2013 08:34 19788638288 ROBERT BENT #5064 P. 007/009 F 1346—91 (iM) 9.4.2 Openings tor 0bJe0--A solid faced sphere test object with a maximum breadth of 4.5 in 9.4.3 Pnwdture-••Tbc cover shall be fitted in accordance with the cover manufacturer's instructions. The test object shall be placed at or into any existing opening and apply a force 3 ~ of 40 lbs(plus or minus 1 pound) steadily to ensure the test object cannot pass through at the following eritteat openings: 9.4.3.1 Any opening between the edge of the cover and the deck surface and coping wall,or both,or the top surface of the spa or pool. 9.4.3.2 Any opening in the major component of the cover. 11). operadug COMMIS,Safety Covers r70a 10.t The open-close switch shall be spring-loaded or of the Nc�v t -•area-te,6 ie? momentary comet type,so that when released,the cover stops Nrnu 2--Paimetor-MO in. oration immediately at any point in the open or closed cycle period F14.2 T emplat°(or Swtmming pact cow Stanqad 10.2 'rhe cover shall be reversible is direction from a tb)l stop at any point in its travel without having to complete the as any quantity of water which completely covers the torso of firll open or closed cycle, the surface drainago test object. 10.3 Electrically operated control switches and motors shall 9.3.2 Procethnn---Test the cover by spraying water evenly be installed in accordance with the National Electrical Cade Over the area at an applicadon rate of 10 gal/min per 10001t= Article 680-26. (9.29 m2)of pool area for a period of 30 min.During this test, 10.4 The type of pool covering operating controls shall be all equipment shall operate in accordance with cover maaufac- such that: turer's instructions. 'Thirty minutes after comple ion of this 10.4.1 Its fixed location is in the line of sight of the procedure,rho covor shall pass the test method in 9.3.At all complete pool cover,or by its operating process.This ensures tines during the procedure, maintain the pool level at the that the operator shall be in complete view of the cover at all watefte. times during the closing or pool covering process. 9.4 6pe ings Test: 10.4.2 Switching devices shall be key-operated or looked 9.4.1 These tests shall be conducted to demonstrate that any away.or able to be de-activated or otherwise located in an openings remain small enough to prevent a small child's head inaccessible location. An inaccessible location shall be at a from gaining access to the water, height of at least five feet above the deck, ANNEX (Mandatary Inforawdon) Al. RATIONALE AU Scope A1.3 Terminology A).1.1 Although the mAjority of child-drowning and near- A13.1 Consumers and new manufacturers may not be drowning which were reported did not involve safety covers, familiar with the teebaalo&al leaguage used within the text those who purport to provide a level of safety should be held -his section also provides definitions for new um created for to a higher level of mliabiliry.injury reports made available this standard from CPSC indicate that male cbildron,one and two years of age,liviag in a home with an in-ground pool are at the highest AIA Cover Classifications and hGaimum Quali6eation risk of Wag involved in a submersion incident that requires Crtterla medical care. A 1.4.1 By defining both the level of safety afforded and A1.2 Referenced Documents standard requirements W be satisfied, manufacturer and COA- A1.23 Allows document reviewers the necessary infonnna- sumer win be able to define their needs and properly interpret don to validate the text of the standard. 06/20/2013 08:35 19786838288 ROBERT BENT #5084 P. 008/009 ' F 1346—91 (2003) the standard. This section also allows manufacturers to M. A1.7.11 Packaging is,at times,the consumers fuxt exposure search and develop new teehnalogy which when applied could to product information.Information contained on the warning change their designation, label is necessary for making informed cboices. A1.8 Materials and Manufacture A1.7.12 All labels shall note that the product meets the A1.S.1 v requircmats described in SpoeiRcetion F 134 , crying lead times for material availability restrict or delay immediate compliance with this standard; AIA General Requirements for Safety Covers At A Performance RegWremaata For Safety Covers A 1.8.1 Installation can 6 a key factor in the afectiveness of A1.6.1 Specified toad factors represent the 95th percentile a UMy cover whether it is manually or power installed. for a child under the ago of five as well as one male adult and' A1.uit. for second ow markings are necessary ct allow a one female adult. met.continuity far second owners and consumer/manufactutor con- one 1.6.2 if one child should gym'gain access t4 the surface of the A1.9.3 The mechanisms which secure the cover are an cover, another child in the area of the pool should not face integral component that help to defeat a child's entry to tho increased risk. water. A1.6.3 Recognizing that some residual water will remain ALRA Openings shall not be so large that the purpose of the aftr the surface water is removed,the test has beat devised to cover is defeated. ensure that the level can be maintained below that deemed A1.8.5 Structural integrity is necessary to provide safety. substantially hazardous to a child of three based on data received from the Consumer Product Safety Commission. A1.9 Test Methods For Safety Covers A1.6.4 Openings in the major component or horizontal openings between the cover and solid structure of the pool area A1.9.1 The rescue operation may requirc two adults and the should remain small enough to prevent the head of a small cover shall support the total combined weight to avoid possible child from gaming entrance. The head breadth for a 5th itljury to thOW in the rescue attempt, VW 95111 percentile is petrautilo of a 7 month old is about 4.S in.The smallest mobile represented by the 225-lb male,210-lb female and 504b child. child would be about 7 months old since at this age 50%of A1.9 2 This teat was devised to avoid an opening large children can creep on hands and knees. caough for one child or another child to fall between the edge of the cover and•the edge of the pool when one child of 50 lb A1.7 Minimum Label Regniremento For All Covers For is already on the cover. Swimming Poole,Spas,and Not Tabs Al.9.3 Recoptizing that some residual water remains after A 1.7.1 Labeling on the product allows for transfer of the the surface,water is removed,this test is devised to ensure that information to second owners and temporary users. the level is maintained below a level deemed substantially Ai.7.2 The combination of Signal Word,SafetyAlcrt Sym- bazardous to a child under three years of age. bol and Word Message provides a higher level of warning then A1.9.4 No opening shall exist in the cover or at any point any single efl'at, that the coves'joins the surface of the pool structure or deck A1.7.3 An elfart is being made nationally to make eonsis- ants(which would allow a srnall ehiW's head to gain access to teat the colors used to alert consumers to potential hazards. the water or become entrapped). The head breadth for a Sth At.7.4 Contrast of colors between letter colors and labels percentile 7 month old is about 4.5 in. are necessary in order to attract aaers' atuottion to label lard A1.10 retie control,Saf Covers enable readability. 6 �3' AI.7.5 Letter size:is an important factor in warning legibil. A1.10.1 Operator controlled momentary contact type ity so the consumer can recognize and avoid the hazard. switches afford greater control in the event of an emergency. A 1.7.6 Style of lettering affects tho readability of the At.10.2 Should a child eater the water during the closure warning message. process,the cover shall be able to reverts without total closure. A1.7.7 wanting labels can be more effective if they allow A1.10.3 1t is important in the case of an electrical installa- for reaction time on the part of the consumer. tion to protect children and all swimmers from the possibility A1.7.8 Damaged labels would not provide as strong a of electrocution,which is the purpose of Article 6W26 of the message as neeossary. National Electrical Code, A1.7.9 Due to extended life expectancy of cover products, A1.10.4 Operator observation of the pool during the closing labels cannot be expected to maintain their original appear- process is necessary to ensure that another person does not anct, enter the water during the process.Additionally,the location of AI.7.10 Labeling messages and format should be consistent the activating device or the ability to tender it inactive is from point of purchase to use andlor application of cover. necessary to avoid unauthorized opening of the cover. I 06/20/2013 08:35 19786638288 ROBERT BENT #5064 P. 009/009 F IS"-91 (2003) Af31Mf IntarnogxW fakoa no poa Um mapawv ftro v/kW ofww patont aphis asumv In oonrractma with any Mom monume In fide sfan"Umm of tMs atsndard ara avzvroaafy advised dmt deterrrdnafiarr ofMo vd*Qt any such Patatrt tights,and Iho ask ofhmblpanfanl etaudl(bm,ara oAW*disk awn M*W This atandofd is w4da to rmNafon w any Mma by Uw rospwraibfe rodwow oommfdoo and moat bo rawamd awry owoyatars and Aot n6viaei4 atM+a MwProwd or wfmwr&^Yburamwis om Inmed vow forroviatp at thfs ataedard or tareddhwW Mndards snd WWW W aOMod 10ASTM Intarrrmgonal hfaadgrrrtors,Yowoomm o vA mmm mmAd touNwodw of a mootbrg of ow rasp&Wb m tsefmfesf awmam rAth you Rwy attend N you lgpf Ihof yaw oommonts Irara no rmhard a fair hmdm you shmv MMA ynw vlswa knewar to Ufa ABTM Commldas an SlftrA .st fha addroom sharvn&*** This swWwd Is a>vmhtod oyAS7M lntoma*wwt 1008an•Herb&Orivo,PC Box C700,Nkaf Cm&Wodmtb PA ISQI6 Mik Unbd States WvAml ropfnhf(aim►or muolo aa{+W of On standard may bo abtakind by oenucdv AM at fha abavo address or of 6104L% 6 (pharwA 01"22-UN(WX or aorviaefasbn wg (a nW); or Numoh Uw AM wtrosMo. lwww.uaftorgA i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel. ' Application dealth Division_ - Date Issued Conservation Division >� Application Fee Planning Dept. - Permit Fee Date Definitive Plan Approved by Planning Board _ 3 ` Historic'- OKH _ Preservation/ Hyannis Project Street-Address 6-0 t2&1,t JAW Village 6t Z Owner /J/ o C> Address_ DO Telephone 0 r pq a Zed Permit Request o MA Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Tdeai net Zoning District Flood Plain GrX water ve lay ro'ect Valuation (® o tr r� l� � J�I31 Lot Size �•CQ Grandfathered: ❑ Yes ❑ No If yes, attach su porting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure md Historic House: ❑Yes No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl Walkout ❑ Other Basement Finished Area(sq.ft.)_ Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing, new Number of Bedrooms: existing new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: �Gas ❑ Oil ❑ Electric ❑ Other Central Air: A(Yes ❑ No Fireplaces: Existing_ New _ Existing wood/coal stove: ❑Yes,>(No 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 play; review# _ Current Use - - Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Z7) 13 7-4 Name Telephone Number 'o 0-e-D - Address 4 6 License # y7 Home Improvement Contractor# _ •° Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO An/01W 9/ h- AgJ7 — SIGNATURE DATE K ' ffi{ FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED R �'MAP/PARCEL NO.. .:,... r ADDRESS - VILLAGE OWNER P , DATE OF INSPECTION: j_.,AFOUNDATION ' 'I ' 'z FRAME i .INSULATION-� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: , vp—, ROUGH m-.;,,­,,,, FINAL FINAL BUILDING .DATE CLOSED OUT.. a , i' ASSOCIATION PLAN NO.-,; ,t ' - The mina Co 4 nwealth o Massachusetts f Department of fndus ial Accidents • - Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers A0pheant Information Please Print Legibly Name(Business/Orgamatondndividval): r Address: 1/2 City/State/Zip:" Phone Are an employer?Check appropriate bog: Type of project(required): 1. I am a employer with 4. I am a general contractor.and I employees (full with part-time). # have hired the sub-contractors 6. ❑New construction 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. 7 Demolition working for me in any capacity, employees and have workers' 9.. 0 Building addition [No workers' comp. insurance comp.insurance.$ required] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Pltunbing repairs or additions myself [No workers' comp, right of exemption per MGL 12.❑Roof repairs insurance required]t c. 152, kl(4),and we have no employees. [No workers' 13.El Other . comp.insurance required.] applicant that checks box#1•must also fill out the section below showing their workers'compensation policy information. &A�ny Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such ,contactors that check this box must attached an additional sheet showing the name of the sub-contractor 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 joh site information. Insurance Company Name:_ Policy#or Self ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: .Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,-as weD as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violatot. 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_cerlify u t e pains aifi of perjury that the information provided above "true d correct -Si __Date: �Phone� '- e 3 Z4 Official use on . Do not write in area, to he completed by city or town official City or Town: Permit/License# issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5..Plumbing Inspector 6..Other Contact Person: k. Phone#: Information and -Instructions A Massachusetts General Laws chap ter 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 ofhire, express or implied,oral or written." partnership,association,corporation or other legal entity,or any.two or more ...' An employer is defined as"an individual,p p, - 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,employ' '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." I Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter•have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking-the boxes that apply to your situation and,if. of necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the' members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial . Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please.call the Department at the number listed below. Self-insured companies should entcrtheir 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 fhe 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 Sits Address"the applicant should write"all locations in (city.or. ' town),"A copy of the-affidavit that has.been officially stamped or marked by the city or town may be provided to the• . . applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled.out each year.Where a home owner or citizen is obtaining a-license or permit not related to any business or oomm`ercial 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 CommanwDalth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel, #617-727-4900 ext 406 or 1-877-IYIASSAFE Fax# 617-727-7749 -evised 4-24-07 www.mass.gov/dia Client#: 10798 2RILEYCJ ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/06/2013 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 PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. RTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)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 endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil a/c PHONE Ext:508 775-1620 (FAX No): 5087781218 Insurance Agency E-MAIL 973 lyannough Rd., PO Box 1990 ADDRESS: Hyannis, MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Grange Mutual Insuranc INSURED INSURER B: C.J. Riley Builder,Inc. P.0. BOX 382 INSURER C: Osterville, MA 02655 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. INSpR ADDLSUBR TYPE OF INSURANCE NSR WVD POLICY NUMBER MM/LDIDY EFF MMO/LDIDNY� LIMITS A GENERAL LIABILITY MPOS9664 5/02/2013 05/0212014 EACH OCCURRENCE $1 00O 000 X COMMERCIAL GENERAL LIABILITY PREMISES�aoccurence $500000 CLAIMS-MADE I OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1 OOO 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 PRO- POLICY JECTEl JECT LOC $ ITOMOBILE LIABILITY M9059664 5/02/2013 05/02/201 COMBINED SINGLE LIMIT Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident $ AUTOS AUTOS ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident A X UMBRELLA LIAB IV I OCCUR BINDER359107 5/02/2013 05/02/2014 EACH OCCURRENCE s3,000,000 EXCESS LIAR rl CLAIMS-MADE AGGREGATE s3,000,000 DED I I RETENTION$ $ A WORKERS COMPENSATION WCO59664 5/05/2013 05/05/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500 OOO OFFICER/MEMBER EXCLUDED? F_N] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $5OO OOO It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S110879/M110878 LSi Town of Barnstable 0 Regulatory Services F Thomas F.Geiler,Director , ,��' Buflding DIVISIOII Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www town.barnstable.ma.ns Office: 508-862-4038 Fax 508-790-6230 Property Owner-Must - Complete and Sign This Section If Using;A Builder- I, -Tam k OC' s 0*"-k C.,e— , as Owner of the subject property, hereby authorize_ �— _ - - act on my behalf, in all matters relative to work authorized by this bui d4 pemnt 100 iA7 C1A ,\ m a�o Widress 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. ;• S f e of PPli Print N21ae Pant Me • 4 Date Q:FORMS:OWNERPERhWSIONMDLS 0012 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supcn-isor License: CS-066147 nriv CRAIG J RILEY t'�_ r FT PO BOX 382 , OSTERVILLE NfA 02 ,5�5�' W Expiration Commissioner 02/05/2015 Tfie °� License or Office of Consumer Affairs&B siness Regulation registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration-date. If found return to: Registration: 1257gg Type: Office of Consumer Affairs and Business Regulation Expiration: 1L30/2014 Private Corporatic 10 Park Plaza-Suite 5170 i Boston,MA 02116 WCILE BUIL@ER C , 1 m . � CRAIG RILEY _ 10 B WIANNO AVEi..4 OSTERVILLE,MA 02655. , .. y Undersecretary N a' thou t signet >6® D .� 1.310 l0'-0�" 3I_oil Front View Back View Side View Existing Lawn ` Pat10 00 Wit; Bor Existing , S�tK • Lawn 3 R Screen Porch " � • orth Patio Not Tub • Fireplace 0i - • - 101 II • � Fence, • � Shower • • ool Utilities •. . Deck 9� mown • Toble CD 41-v,— _ l Deck G Ill Dor Se^• til 000 , Lown Porch o I Hot Tu , i \T (:i='iI K� Q L IO I �\ i \\ %= 0 l,J �q I 8ELl°JWI LELI ON sj M 4t y � y klk F� nv 0Q/ SELI JWI 9ELl °JWI 4r z: �t Town of Barnstable Building Department - 200 Main Street BAMSTABLE, * Hyannis, MA 02601 9�b 16.39. ,�'�' (508) 862-4038 RFD MA'S a ifiOccupancyCert cate of Application Number: 200902399 CO Number: 20110116 Parcel ID: 016012 CO Issue Date: 08116111 Location: 100 OREGON WAY Zoning Classification: RESIDENCE F DISTRICT Proposed Use: SINGLE FAMILY HOME Village: COTUIT Gen Contractor: E.B. NORRIS & SON, INC. Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: C.O. FOR MAIN HOUSE Building Department Signature Date Signed TOWN- OF BARNSTABLE 3` uj-d in g . Application Ref: 200902399 • BARNSTABLE, Issue Date: 07/15/09 Permit 9 MASS. 039• Applicant: E.B.NORRIS &SON,INC. s Permit Number: B 20091231 Proposed Use: SINGLE FAMILY HOME Expiration Dater 01/12/10 Location 100 OREGON WAY Zoning District RF Permit Type: REBUILD HOUSE AFTER TEARDOWN Map Parcel 016012 Permit Fee$ Contractor E.B.NORRIS& SON,INC. . Village COTUIT App Fee$ License Num 015851 Est Construction Cost$ Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND REBUILDpNEW MAIN H OUSEi-6 BEDS, 5 BATHS, 2 CAR ATTACHED THIS CARD MUST BE KEPT POSTED UNTIL FINAL GARAGE, _ J INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: REILLY,GRETCHEN A BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: PO BOX 587 INSPECTION HAS BEEN MADE. COTUIT, MA 02635 Application Entered by: RM Building Permit Issued By: THIS PERMIT CONVEYS N6RIGHT TO OCCUPY"ANY STREET,ALLY,OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY ORPERMANENTLY. ENCROACHEMENTS ON PUBLIC PROPERTY;NOT SPECIFICALLY PERMITTED UNDERTHE'BUIWING CODE;MUST-BE APPROVED BY,THE JURISDICTION. STREET OR ALLY GRADES AS WELL AS DEPTH.-AND LOCATION OFTUBLIC SEWERS MAYBE OBTAINED FROWTHE_DEPARTMENT OF-PUBLIC WORKS: THE ISSUANCE OE:THIS"PERMIT DOES NOT.RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION,REST RICTIONS: . MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: --1.FOUNDATION OR FOOTINGS. I ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4. PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A).. rW- ` t BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 2 N zt-� 61e sQ 2 ,(/�1- y,Q 2 3 1 Heating Inspection Approvals Engineering Dept �tit� r ra s • �-� - � b �,t.n. Fire 1 �1 .,, � 2 �'� o THE r°' 'own of BarDstable Regulatory Services Y t ass , Thomas F..Geiler,Dir&tor i6sq Building Division "`ran►w.�" Thomas Perry, CBO,Building Con-missioner 200 Main Street,.Hyannis,MA 02601 , www.town.barnsta b le.ma.us Office: 508-862-4038 f Fax:. 508-790-6230 PLAN REVIEW Owner: .T)ec Map/Parcel' Project Address lC &XC-6v /U dTBuilder: �57 The following items were noted on r6viewing _11a u.si5- /s. %ire o©.boW& -� Sjat CI</C A0 7,?0 OV �2 /Z0, �r rU f'; 7POG'•!(R/Zo.SOI.l2- ;(15 114.t 4X�ltitctyx �/G1T. /�ol� G�4��E 7`0 G'f�iVNo T SC G D l�L/SKI �N i 0, Reviewed by: !� Date: Q:Fo,=:.Plnrvw 9�7z E AJo-re 7oi'o-P ll i 01P � o / NOTE: P.T. SILL ELEV.11`1 1 0 �P , Ilk01 •O , i fI o o OG�G�'C�aOlnI' L(Wl�l Il - i i i • "I certify that thefoundation shown on Of PLOT PLAN OF LAND this plan is as it actually exists on the �`jN LOCATED IN ground and that it conforms to the town of o`'� DAVID COTUIT,MAS S. Barnstable zoning regulations regarding CHARD*£ PREPARED FOR yards ." S ►cm E.B.NORRIS,BLDRS. • backs _ _ S �,NOE DATE:SEPT.9,2009 SCALE: 1 "=40' date.Sept.9,2009 CAPE & ISLANDS ENGINEERING flood zone A13 EL.11 MASHPEE,MASS. - ys ` Anderson a 781-857-1000 Fax 781-857-1054 Insulation, Inc. www.andersoninsul.com 706 Brockton Ave PO Box 2003 Abington, MA 02351 _ Insulation certificate WORK AREA ITEM INSTALLED Underside of Roof R-32.4 Icynene Open Cell Foamed in Place Insulation-9in Gable End Walls R-19.8 Icynene Open Cell Foamed in Place Insulation 5.5in Overhang R-32.4 Icynene Open Cell Foamed in Place Insulation-gin Under Flat Roof Deck R-32.4 Icynene Open Cell Foamed in Place Insulation-9in Garage Ceiling R-32.4 Icynene Open Cell Foamed in Place Insulation-9in EXT.Walls 2x6 R-19.8 Icynene Open Cell Foamed in Place Insulation 5.5in Blockers/Rim Joist R-19.8 Icynene Open Cell Foamed in Place Insulation 5.5in Garage/House Wall R-19.8 Icynene Open Cell Foamed in Place Insulation 5.5in ; Basement Ceiling R-19 6 X 16 Kraft Faced Fiberglass Eco Batts Garage Ceiling R-30 10 X 16 Kraft Faced Fiberglass Eco Batts R. Garage Walls R-19 6 X 15 Dryright Poly Faced Faced Fiberglass Batts , Ceiling R-19 6 X 15 UNF Fiberglass Eco Batts . Kneewalls R-19 6 X 15 Kraft Faced Fiberglass Eco Batts Customer: E.B. Norris&Son Builders Job Number: 161745 Job Address Joyce Res 100 Oregon Way Cotuit ' 100 Oregon Way Cotuit,MA Date Completed: )'tw' 14 I d In I r Signature , OiSAA10 x t 1 --K' M A0 M'Moi 1212212009 17:07 P.0021002 -,z�d rson Insulatlon Incorporated 7o6 Brockton Ave's P.O. Box 2ooa's ington 1WA 0'235' w 12/22/09 Re: 100 Oregon Way- Cotuit' �' �,C,�.t,rrt - Dear Bamtable Building Department« Anderson Insulation installed the following work areas at the corresponding R-Values with Icynene Open Cell Sprayed in Place Foam, '.Work Areas It Values Exterior Walls, 12.6 ,.14.4 7Y. -l. 19.8 21.6 Rim.Joistsx 12.6 144 19.8 21.6. _ Basement Walls 12.6 14.9 19.8 21:6 Slopes 21.6 28.8 -32 4 '36 0 Plat Roof becks 21.6 .28.8 32.4 36.0 39.6 Crawl Ceilings .21.6 28.8 32 4"'" 36.0 39.6 Overhangs 21.6 28.8 32..4 36.0 39.6 ' Underside of Roof 21.6 ` 28.8 '" 32.4 36,0 .. 39.6 Garage Ceiling 21.6 28.8 32 4 36.0., 39.6 . ® lcyaene's R-Value Is formulated by multiplying the R-Value per inch�'which is 3.6,by the number of inches applied. Icynene R,Value=3.6 x Inches Applied. The fiberglass that was installed-has the necessary R-Values printed right onto.the Face of them. _ The foam was covered by anti-ignitida barrier where required. - If there are any;quesiions or concerns please do nqt hesitate to call 781-8$7-10QQ{ Robj Anderson IR 1 j. i f t � 1 1 i /eo 'A r o Liberty Mutual. The Ohio Casualty__ins—u—mace Company Dt=F1 'f _ CONTINUATION CERTIFICATE In consideration of the payment of a premium of$ 100.00 The Ohio Casualty Insurance Company hereby continues in force to May 18,2011 its bond No. 5052511 effective May 18,2009 ,on behalf of E. B.Norris&Son,Inc. , Principal, in favor of Town of Barnstable , Obligee, subject to all its terms, conditions and limitations as set forth and expressed in said bond. This certificate is executed upon the express condition that the company's liability under said bond and this and all continuation certificates issued in connection therewith shall not be cumulative, and shall not in any event exceed the amount set forth in said bond, or said amount as it may have been increased or decreased by any rider(s) or endorsement(s) properly issued by the company. Dated this 3 day of May 2010 The Ohio Casualty Insurance Company Martha A. Kenney Attorney-in-Fact S-168 Principal: E.B.Norris&Son,Inc. POWER OF ATTORNEY POA Number: 40-463 THE OHIO CASUALTY INSURANCE COMPANY Obligee: Town of Barnstable WEST AMERICAN INSURANCE COMPANY g Bond Number: Know All Men by These Presents:THE OHIO CASUALTY INSURANCE COMPANY,an Ohio Corporation,and WEST AMERICAN INSURANCE COMPANY,an Indiana Corporation pursuant to the authority granted by Article Ill,Section 9 of the Code of Regulations and By-Laws of The Ohio Casualty Insurance Company and West American Insurance Company do hereby nominate,constitute and appoint: Mark McCartin,Robert W.Miller,Kelly C.Bolton or Martha A.Kenney of Hyannis,Massachusetts its true and lawful agent (s) and attorney (s)-in-fact, to make, execute, seal and deliver for and on its behalf as surety, and as its act and deed any and all BONDS, UNDERTAKINGS, and RECOGNIZANCES, not exceeding in any single instance ONE MILLION ($1,000,000.00) DOLLARS, excluding, however, any bond(s) or undertaking(s)guaranteeing the payment of notes and interest thereon. And the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Companies,as fully and amply,to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected officers of the Companies at their administrative offices in Fairfield,Ohio,in their own proper persons. The authority granted hereunder supersedes any previous authority heretofore granted the above named attorney(s)-in-fact. In WITNESS WHEREOF,the undersigned officer of the said The Ohio Casualty Insurance Company and West American Insurance Company has hereunto subscribed his name and affixed the Corporate Seal of each Company this 7th day of January,2008 P�SV INSU PN INSU/7 4N SEAL o; .12 b y, SEAL 3, Sam Lawrence Assistant Secretary STATE OF OHIO, COUNTY OF BUTLER On this 7th day of January,2008 before the subscriber,a Notary Public of the State of Ohio, in and for the County of Butler,duly commissioned and qualified,came Sam Lawrence, Assistant Secretary of The Ohio Casualty Insurance Company and West American Insurance Company,to me personally known to be the individual and officer described in,and who executed the preceding instrument,and he acknowledged the execution of the same,and being by me duly sworn deposes and says that he is the officer of the Companies aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and the said Corporate Seals and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,1 have hereunto set my hand and affixed my Official Seal at the City of Hamilton,State of Ohio,the day and year firstabove written. 0iuunuutry `�4'0 * Notary Public in and for County of Butler,State of Ohio My Commission expires August 5,2012 This power of attorney is granted under and by authority of Article III,Section 9 of the Code of Regulations and By-Laws of The Ohio Casualty Insurance Company and West American Insurance Company,extracts from which read: Article III,Section 9. Appointment of Attorneys-in-Fact. The Chairman of the Board,the President,any Vice-President,the Secretary or any Assistant Secretary of the corporation shall be and is hereby vested with full power and authority to appoint attorneys-in-fact for the purpose of signing the name of the corporation as surety to,and to execute,attach the seal of the corporation to,acknowledge and deliver any and all bonds,recognizances,stipulations,undertakings or other instruments of suretyship and policies of insurance to be given in favor of any individual,firm,corporation,partnership,limited liability company or other entity,or the official representative thereof,or to any county or state,or any official board or boards of any county or state,or the United States of America or any agency thereof,or to any other political subdivision thereof This instrument is signed and sealed as authorized by the following resolution adopted by the Boards of Directors of the Companies on October 21,2004: RESOLVED,That the signature of any officer of the Company authorized under Article 111,Section 9 of its Code of Regulations and By-laws and the Company seal may be affixed by facsimile to any power of attomey or copy thereof issued on behalf of the Company to make,execute,seal and deliver for and on its behalf as surety any and all bonds, undertakings or other written obligations in the nature thereof; to prescribe their respective duties and the respective limits of their authority; and to revoke any such appointment. Such signatures and seal are hereby adopted by the Company as original signatures and seal and shall, with respect to any bond,undertaking or other written obligations in the nature thereof to which it is attached,be valid and binding upon the Company with the same force and effect as though manually affixed. I,the undersigned Assistant Secretary of The Ohio Casualty Insurance Company,American Fire and Casualty Company and West American Insurance Company,do hereby certify that the foregoing power of attorney,the referenced By-Laws of the Companies and the above resolution of their Boards of Directors are true and correct copies and are in full force and effect on this date. IN WITNESS WHEREOF,I have hereunto set my hand and the seals of the Companies this 3 day of May 2010 JP�jV INSOp_ `Pp INSpRq o; a' .o o, SEAL yi SEAL o dy, 2 ;• ;i Mark E.Schmidt Assistant Secretary DAVID O .' KNUTTUNEN , P. E . Structural Engineer May 03, 2010 a K way Mr. Robert McKechnie,Building Inspector Town of Barnstable Building Division :: w f 200 Main Street Hyannis,MA 02601 Cn RE: Joyce Residence -- „ w 100 Oregon Way, Cotuit MA Permit#B20091231 Dear Sir: This letter is to certify that: 1. My design of the Joyce Residence, 100 Oregon Way, in Cotuit, as documented in Structural Drawings S-1 thru S-11, dated 23 March 2009, conforms to the relevant structural provisions of the Massachusetts State Building Code, 780 CMR, 7, Ed., and that, 2. I have made five site visits during construction to observe the installed structural elements, and have also reviewed comments and photos from construction observations made by the Architect, K. Marshall Works of Archi-Tech Associates, Inc. of Cotuit MA,and that,based on those site visits and other observations, 3. To the best of my knowledge and belief, the.referenced structural work is in accordance with my structural design and the above-cited Code provisions. Very truly yours, Ilk®P AAS�, DA 11 o. mom` 6W11TTllNEN STRUCTU RA C3 No.32306 GIs David O. Kn ttunen,P. E. �FSS�ONAIL Mass. Reg. No. 32306 CC: K. Marshall Works (ATA), Craig Ashworth (E.B. Norris) 24 BRIDGE ST NEWTON, MASSACHUSETTS 02458-1125 phone: (617)558-5853 fax: (617) 558-5803 • email: dok@dokpe.com world wide web: http://dokpe.com L RA N GA NDEN A' REA / ` ti on �1 / i0' it �� F 10001, DRAJ, AVG. \49" 36"-60" f ( / / i• / / III =III=I 116, MIXTURE min // -�- / III=I I_ 50%LOAM III 50%SAND , ti =III=-t SIN GARDEN SE o o� le vs og. G f' I)j 10 OUND / 1 p00G�A HARVEST a1000 CA LVRO -1 R vc . +\ l ; \6, ` �fl.bST�G 1500&pip \ i CTA 0REMAT� i - v. s ,. N • w to �� \ � +-----�•----�., � � . ;t.� �,1 GAS \ \ 6� TAP + \ \ T Q� �AG i . `; q.5� 28.00 0o 50 0�O o �0 _e ��1�1 WQ x "I certify that the foundation shown on . w05 - this plan is as it actually exists on the 1 ground and that it conforms to the town of ' 6 Barnstable zoning regulatio regard's yard jacks. �F alyss9 14.00' - - - DVID G4 18.7' 18.5' o CHAP!_5 - date Oct.Z2009 5?808 Ks. E flood zone non hazard y e �fGISTER�� � 4 r S�NAI LAND S� PLOT PLAN OF LAND LOCATED IN ' COT�UITMASS. PREPARED FOR 313.10 E.B:NORRIS,BLDRS. N65°295p„W DATE:OCT.2,2009 SCALE:1"=40' ` } CAPE & ISLANDS ENGINEERING $ MASHPEE,MASS. k . TOWN OF BARINSTABI_E 70 OCT -b AM It: 38 DIVISION Y S 4 r i Al -710 r� Y`'-Y j }b 1 I i � IJ 1 f, APPROVED BY: SCALE: I -- ` L✓ DRAWN BY DATE:V REVISED �. si -� O DRAWING NUMBER 0"64t Detall-NTS General Specifications Main Drain-NTS - — size: '(j Depth: -3 '(_, To: Area: ❑ Perimeter. OM QUALI ' Y COPIKC P:OOL 3/4•Conduit to Shape: -4 /.�/ r FiNlot b rbrp Deck box Pool Capacity: !>p OALs Mtlrosbsx Gown 1'Above want Lewd Filter Model: �✓ �� .. � z'Mi. � FT. NOW Model: t �' • r fiydwsaau�v.w. � PAP Capacth►: �v tiPM Turnover: Ellis p Bs>rs e•ok borax� Ground Lag kimnrtar Model: _� ` 1..t Main Drain Model: ,L..✓s'l «c.v - .�'V� - 4000 P31 Bkimm"": • Main Drain: Lino b Vsaarm erooloot SW*Suction •, Add N3 Bari as shown i lOV MOW U t ° Cagetion Tubs 2.fow Rettuns: � o• t trr slot» •° Pool Cleaner. Backwash To: b— '"` Calla4glAwA DAhNs Only: CapinD' `//7 8i(ti1NEEer Section-NTS f A N)P A 0PA&j S Tile Color: � .-- l#jG-S 'i�Jp�+d NL�I . SSv i ttS Ladder'' swknotit: �\ ► Q l STU R`` Q S� Board Was: Fkah 9hlinow C*p C eh PrJ Cs � cnorrs � O o %bI L. (s w � so rAht.� , � av W ❑ s W o �'� so o Con**: short T3< Long 0 i "i"�""`` ^.w e o ` 1 ,0Pk A-f& &'`U ZX rd>& Rope�: • t�rr.e 11 WoMt IaysA Wrisilon b O �P��N OF M.6 -� Heater Modet: _� ems. ? BTti .' .. PAUL A. Cs�, Nat"file Older Pr+OpaRa ❑ C AV001A Bond ' PHEE AN JR. Fuel: Bos1n oaatd _ • � o STRUCTURAL V. . , - ddntsttan wMo 43& 4e Reber /� a No 42536 Vandal By: Gasorne By: Dram Divater: Yes El x pvc b o,.re a Cortrttonehl Dole .1� Electric By: ElecUic Bonding By. R: trump PkprrNp: Yes No P*ft A1111111111111i TO BE FENCED PER Tile a Copp: As,,r•❑ oTN ❑ B~Y ON CITY ORDINANCE. Gig: _ Tir IN SELF CL081NG stumping,ETC: �--_ • IMIP O&P LATCHING BY OWNER. - - Decks By: Additional Specifications -� —, .� Addendum: Date: - ---- ------ - - - Ga✓ 4-e-✓. Depth Profile - Salesman: Dwn By: Scale: 1/8" = V- 0" Date: Water for Gunite Job Nu ber: Set Backs FR. Side Rear -- A*+zo Swimming Pool For - - - 2�s Standard Wale Section-NTS y �b\f�� e: _ .. �� �����cI Cr r � r.d G A00ress: /4 r _ �.ej Aj -ir brick Coping t� Town: s State: con�no4s tM.a Sam «/r 56 �' �' O .TE75 CJ - ONE i/E /.SSff E L.,� Job Actress: w/#3&04 Up i t- ��� �- � Town: •• 6•Ce State: Zip: a� Ceramic r Ides. Phone: Bus. Phone: �a•MIS whoa 7►IX Fill « Mariite pincer finishr- 4 Of WOK �P i'Min Thickness �"Min Carver f1Ale;Derti � _ _ 3TOM QUALITY POOLS Kni w 17 o/c both vrar rf - - - Swimming Pools in Gnsite WIas 1'R Max a� t 6•Ceramic Tile %ti S-O,� `� r% 16, Wyman Road, Billerica, MA O!821 � Rack Pick: (978) 663-8290 1AV'j JO N11,01 _ Total bowl of pool ' I ...i> >n■o.....a■w.7w ThIrknns tr 2 0c - / DRAINTECH e•ATRIUM POLYOLEFlN ORATE RA aaaFigure 1.3 presents the nitrogen cycle as it may apply to bioretention,together with the1�A4 .•,' b / / , X GA RPEN A REA REWAIRED - 600SE SLOPE TO MAIN various natural processes. ___T •y / COMPACTED , J rl •'ado► S / / / / EARTH L f 1 J . 00 AIR �"`' / 1,OD / / 10' 12' A I - �H 1 i / R%1\1�I I i0. /� ✓ �Q / / vnwEs .3Rnl r1 Alt. T. I" ✓ ^� / / /4"WEE \ �\ 4*f a ��111'.1 _ _ / r�/�/ ✓�/ /�1 / / �• DRf1tN EMITTER HOLES . + �� ! � N / "bUBBLER„ n •„H�111,. `'':_ (\ RV / 100, DRAIN RISER RI wn l 7' e•SEWER E \i N h �•� ,��/ 0 • S ./3" / / —I I I 9'AVG. n „ DRAnNRECH „rTn0.� --. .- . .n.n Tr��. "- •r i' 36 60 III= ,F / III =1 I I —III BASIN �� 0 a _ _ '_—III— III �,ER a DRAIN " , . • 111 r/ / two III —III=1 I i " G [ ]—I I 1=1 I I—I I I— �� ,T�/�AEIASE CTED�t RANOIAL,ATNM 6 MIXTURE min Iy�WL17A N �� �► lV � �' ,b /,�� � /II � � / III=III=1 i I Soo/a LOAM = I-== 1= � fl a so/G SAND I I I I III :�• ,t / w \ ROOF RUNOFF / ! i 0/ i �,.l�I) /� / / R.AIN GARDEN SEj,'TION �.: � �� r,' � :�h _• „ _ / b �� �� / DRAINAGE EMITTER Fig. 1.3 Nitrogen Cycle for BioretentionAll � ` v / • I C11h1, / Ai t . Nitrogen Transformation Formu.a / / / 1 1 ',• �� ,� _ �.. /•. 1 "� ' I 1 UPD/1Tm OM1NlO Tit OM,ile7 c" !I y I \� rev. or. noN ev I wwoonr I wcv 2NHt+3Q 2NO2 +211'+21I10 I f • i / I rr/ws AM A•OTlelSIN/eLw aces 2N0= +OJ 2NO3- I- / ?1.• 1 i / 1\\ 1 \ 9E7 Ids AND�l CYSR •NILMFO.OHIO 43M / •' -r i- —� , ,......tid.� Y.I_I�,.._,..,.,.\ep>.., '.,v.lw.i.--� !•,.•:b 1 -l.Ib�lP.q,gr•.AI -_.1 / \ ,� •� I �� \ 4," Compounds and F.lemenlc Defined: • I �/ / �)y `ale o is / 5 Z / /� / IN \_� ^\ �7 ,, NH3 Ammonia NH4 Ammonium Ion 1 �� � '� Nz Nitrogen Gas NO3 Nitrates (j � / N OZ Nitrates 2H Hydrogen Gas 2H2O Water 02 Oxygen / ^ ` /� / / •' 1 — t' t' I ``t J~ \ �I I Nitrates are highly soluble and can infiltrate into and contaminate groundwater. To/� t t � 46 \13 SJ' minimize this problem,an anaerobic area can be designed into a bloretenhon facdity or it Noll l • \ �! ` �1\�, j/ 1 I t C) t R���� _I _ can be lined to prevent infiltration s�cTlol+MMMF17NO ARE AVAItAetE SE �'' °' IN 1 FES,WYK REDUCERS,4r aErDS AND l • V I 1 \ %i/.p I Ir18`v� 6'',`(O,� scweeu COUPLERS ,6 WATERTIGHT MWr1.D14M% "SOIL-TRiR 15„ r ' .-<( i AYV•`OJD 0 � �� \ \ \\ 0, / FITTINGS ARE Al.90 AVAWAE RI11l fN4G / L ACr 111 / �l w ��� . 1 �.•� 1:.� ��11° : 6 ' �i \ � � � — f'` vE — � + // VX Is— ' e �II\\. ',t 11.1 all ,1 1 ^ \ \\\ �. Gt'Q �t Nnar;A GRADE wR90GIN na DOWNSPOUTR-ED ADAPTER ADJUST GRADE PER BJdrEERB IKSE R-ED i4 RISER \ ( 1 , • / 1` F!4ISIIED GRIDCIt 00 _ IC _ T / INACTION F. � FL SIN �" \ �� r 1. � L Gc1?7 fti �f2 INACTION IaLDEn WT TEE 1 I w I / 11•� A �L \ / -�' - _-. " "l eG��s 7 - �- `'..� NJECTDN G F,OtI \ r o / MOLDED W1pT K '" v,Gsz ClL ti FIAR p d10°0+ �. 1 1 1 1 �KaME R , 1- �� 10 \ \ + 4 / ' t;�,'11�'.1 t�I,,l c,l:� TO EMITTER I I ( I I R a \ 1 / I °o "- "_"A Ilul9"D ou' / , INSIDF RAIN GARDEN l) STING °o I W ti,oa � olo���;. , � l-�/—�• c� ,.�.� ,� . � GOp G.iA)fvL ' ,• / ghi ��s ma's ,��cE _ / HOPE PPF!VP, lip le\ CTAOREM A V07 tc*41VII; —, I.r I CIR I jl I II I 1 I :azj. _ s / 4.�i I, W I � III 1 4• � � ��Q , �'/_//ii., •' �:.. , ii% � / % "'� ' 1.i I� �` � �/ � / f • � \� \ � / / ! I III 1 1 1 I •6� '� / �;�,• •��,• � _ — — Ca � — _ — / 6 , ��E is � � / l / / � I I`, I ► I � \ I 1 \ 1 1"51— PATH 70 of a 1 1:P,� ON o \ 1 / ! 1 �►� / 10 \ i o _ 4 __ Rain Garden Landscape Planting List r�' 1 1s�Fe. f I s Common Name Botanical Name 4-10001 ——� CD�O�� w 01 �• „ y° �>-�' :. ��� / 11 ' �1`�+ RAI L \ 8 \ / / / , o�s�l Buffer zone / meadow plants: ( •1��11 " F,on I I / r,�� �� /�� ( \ ! — k1-h, 6\ T�pi + \ / // + !r / / �c11r / I �y \ / Ri�R Bayberry Myrica pensylvanica .. �� / n- > _ n •/ \ 1/ / \ / Switch grass Pamcum vir atum � / \ A �I '�� / I bl• ' l Little uestem Schihzac rium sco arum • 4 / �I \ � � �o � Y P / Indian grass Sorghastrum nutans Pennsylvania sedge Carex pensylvanica / Lowbush blueberry Vaccinium augustifolium \ / �\I �° 1 \ �` b + _ I • ; 1 / Black-eyed Susan Rudbeckia fulgida lv w \ \ �00Coneflower Echinacea u urea_ ) / PrP / Penstemon(beardtongue) Penstemon digitalis . I Coastal shrubland /woodland restoration plants: P TE CWinterberry Ilex verticil lata xrT11� Inkber ry holly Ilex glabra TREELINE / a Arrowwood viburnum Viburnum dentatum /��y / / — �� I I \ lti •� r 1 I \ / -1- ! // / Witherod viburnum Viburr_!?m cassinoides / 10 / / // / Highbush blueberry Vaccinium corymbosum /� / AA� \ \ 10 •—•— 313.10, LOT AREA _ 1 / 1, / / ' Summersweet Clethra, nifolia / / � � / Red chokeberry Aronia arbutifolia / 1p., Lowbush blueberry Vaccmium augustifolium �,.„t, \ \, — _ _ __ — _ �r—• \ 12— Virginia creeper Parthene^issus qulnquefolia _ 1 o l \ \ \ jOQ� _` 1 I l Trees I / / / NOTES: REVD.JULY 10,2008 ADD DRAIN TRENCH AT DRIVEWAY, �� `� �•� \ All) /! REPLACE 1 RAIN GARDEN WITH 1,000 GALLON RAINWATER \ ` - !/i / White Cedar Thhja occidentalis / + PROPOSED PROJECT: HARVESTER SYSTEM �/1 �' I !/; / / I / / // / HOUSE DEMOLITION & RECONSTRUCTION PROPOSED SITE PLAN REV,JULY 14,2009 FIELD CHECK TO DETERMINE —� / PRECISE LOCATION OF EL.11.0[FLOOD ZONE All] / / / / �' PAVEMENT REMOVAL,UTILITY POLE REMOV. LOCATED IN REVISE SITE PLAN . / / / // / / PERVIOUS DRIVEWAY,UTILITIES,STONE PATI COTUIT MASS. / + o�sT�°���' ' / / / / STORM WATER QUALITY MANAGEMENT, PREPARED FOR o G IFtic /� R��R / // / TITLE V SEPTIC SYSTEM [CARRIAGE HOUSE TAYLOR JOYCE /, 1 / / / TURF REMOVAL & LANDSCAPING +h, / / / / ����or'.1r.15•, " _ _ / / / // / ELEVATIONS BASED ON NGVD DATE:JUNE 5,2008 SCALE: 1 " = 20' :r. ��• I�nvlu • FILE: 165BA oregonprop / // TOWN MAP 16 PARCEL 12 CAPE &: ISLANDS ENGINEERING 20 0 20 40 60 �• tj•;r HOUSE NO. 100 OREGON WAY %s / / 800 FALMOUTH ROAD,SUITE 301C ' // / FLOOD ZONE Al [EL.11] & B MASHPEE,MASS.02649 [5081477-7272 /