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0565 SAMPSONS MILL ROAD
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map P cel Permit# h 3312, Health Division 3 f Z �- �i� ' 101 F L A F N S 1A Bf_=gate Issued o� � 1, I Conservation Division 31 ?POE 3 pm 4: -application Fee Tax Collector Permit Fee Treasurer Planning Dept. USTING'SEPTIC SYSTEM LIMITED Date Definitive Plan Approved by Planning Board TO OF BEDROOMS Historic-OKH Preservation/Hyannis Project Street Address Village Owner Q Address Telephone Permit Request A DO 6!1-f Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /'00> 000 Construction Type Lot Size �2 Grandfathered: ❑Yes .kNo If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes )kNo On Old King's Highway: ❑Yes �kNo Basement Type: Y(Full ❑Crawl \❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) `� Z Number of Baths: Full: existing new n 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: ❑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 Knew size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes kNo If yes,site plan review# Current Use roposed Use BUILDER INFORMATION Name L _ _ Telephone Number : E7211 Address . License# Home Improvement Contractor# f Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 7� SIGNATURE DATE ��I �/•� FOR OFFICIAL USE ONLY a PERMIT NO. -f r DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE } OWNER .F DATE OF INSPECTION: Iz 1 i FOUNDATION 0 (1l , 05- � (H)(u� 1n1y-t-A FRAME9 I INSULATION FIREPLACE ELECTRICAL: ROUGH rs FINAL PLUMBING: ROUGH FINAL J —k GAS: ROUGH FINALtr r FINAL BUILDING ' UITt LI'1 . Fri LC DATE CLOSED OUT C) ASSOCIATION PLAN NO. --- I R o u tN c C 04 V 4 cil V J ,�� G-LA S (A4Z pe I��Ep SPEC `1'/i" j2"pG>` The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street r Boston,Mass. .021II Workers' Com ensation.•Insurance Affidavit-General Businesses address: city /�i`/ state: ��0/ zin �O phone# work site location(fall address): ❑ I am a sole proprietor and have no one Business Type: ❑Retail❑RestaurantBar/Bating Establishment working in any capacity. ❑ Office❑ Sales(including Real Estate,Autos etc.) ❑I am an employer with em to ees(full& art time.: ❑Other 1 �l%%%%//%///%%%fi, / � %%%/%%%%%%/. I aIIi an employer providing workers compensation for my employees working on this job.. corkifiin nainet..' ed' 'ss• ,i are l'`;�=':•:`• •••1�° hone:#r 's I am a sole proprietor and have hired the independent contractors listed behiw who have the following workers' - compensation polices: � . , . ' " .. company name: " •` •' - - address: city: lshone'#s , i assurance co. i.. • .. comp Vp an. `n a e address:. *! J insur nc_ o ' •� - _ Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as weII as civil penalties in the form of a STOP WORK ORDER and a fine of$140.00 a day against me. I understand that g copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under t ai sand penalt' o erjury that the information provided above is true and correct_ Signature Date Print name Phone# �. official use only . do not write in this area to be completed by city or town official city or town: ermittlicense# _ ty P. ❑Building Department ❑check if immediate response is required ❑Licensing Board L❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revived Sept 2003) f . I Information and Instructions Massachusetts General I;aws:chapter 152 section 25.requires all employers to provide workers'compensation for their.. employees: As quoted from the 4'law", an employee is.defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased:employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the.occupant of the.dwelling house of another who employs.persons to do.maintenance, construction or repair work on such dwelling house or on the grounds or building.appurtenant thereto shall not because of such employment.be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency_shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting . authority. Applicants _ Please fill in the workers'compensation affidavit completely,by checking the box that applies to your situation.. Please supply company name, address.and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the perrnit 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. . City or Towns . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill...in the permit/license number.which will b�e used as a reference number. The.affidavits may be.returned to the Department by,mail or FAX unless othei'arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you Have any questions, please do not hesitate to give us a call..... The Department's address,telephone and fax number: . The Commonwealth Of Massachusetts Department of Industrial Accidents Since of WesdoMons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 exL 406 P Town of Barnstable Regulatory Services . � ��$ Thomas F.Geil�,Director .. q, 163 �, Building Division �'FD MAi Tomi erry, Building Commissioner 200 Main Street, $yams,MA 02601 WWw.fown.b arustable.ma.us Fax. 508 790-6230 Office: 508-862-4038 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property h authorize:'• Chereby � 0. act on mybehalf; ruatters relative to work authorized bytes building pew application for: . in all . s of Job) C jl j'� r Signature of Own Date Print ame j RESIDENTIAL BUILDING PERMIT FEES App ICATION FEE , New Buildings 05010 Residential Addition Alterations/Renovations 0 Building Permit Amendment $25.00 FEE VALUE WOPMHEET to NEW LIVING SPACE(015 7 64i�i 1 . � "`— x.0041= square feet x$96/sq.foot= plus frombelow(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE - !- (�� square feet x$64/sq.foot= Mill x.0 41= plus from below(if applicable) GARAGES(attached&de t ed) �17� Zoo x.0041= 12�?,�Z square feet x$32/sq.ft. ACCESSORY STRUCTURE>120.sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building Permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS x$30,00 Open Porch — = (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= • (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee 5L �T Projcost Rev:063004 7so CMR Appends:J Table JS.2_lb(eondnued) • procrfptive Packages for One and Two-Family Residential Bull dinge Heated with Fossit Fuel MpXfMUM � Wall Floor Baseman slab HearinglCoolirg Glazing Glaring Ceiling pesimc� Equipment Efficiency' • R-value R-value' R-value° w� 0 Area (/) U-value= tt_value° R-�d Package 5701 to 6500 Heating Degree Dave Normal l3 19 10 6 Q 12% 0.40 38 6 Normal 12% 0.52 30 19 19 10 SS AFUE 13 19 10 6 • $ 12% 0.50 38 N/A Normal -- - - .15%..r.._......_.-.-._... ..--..._- ....__03.6_._...- 3s 13 2S NIA -. _. .. Normal-... .----_... .__...................._ U '15% 0.46 38 19 19 10 8S AFUE 13 25 NIA NIA V 1S% 0.44 38 6 IRS AFUE W 15% 0.52 30 19 19 10 Normal 13 25 N/A N/A X 18'/0 032 3S 19 NIA NIA Normal y 18% 0.42 38 25 13 19 10 6 90 AFUE Z 18 0.42 38 19 19 10 6 90 AFUE AA 18% 0.50 30 1. ADDRESS OF PROPERTY: ✓� '�' ,- 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS. : Lp— 3. SQUARE FOOTAGE OF ALL GLAZING: 4. /o �GLAZING AREA o G #3 DIVIDED BY 42): 5. SELECT PACKAGE(Q--AA-see chart above): INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS NOTE: OTHER MORE ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: N0: a q-forms-f980303a 780 CMR Appendix J Footnotes to Table A2.1b: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the oss wall gr area, expressed as a percentage.Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U=values cannot be used. The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 _._ _ and insulation.and R-38 insulation may be substituted-for R-49 insulation: Ceiling R-values-represent-the-sum of cavity....--. insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing(if used). Do not include exterior siding, structural sheathing, and interior drywall.For example,an R 19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-fi-arae or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned b,Liements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. If the building utilizes eleetric resistance heating use compliance approach 3;4, or 5.• If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. For Heating Degree Day requirements of the closest city or town see.Table J5.2.Ia NOTES: a a) Glazing areas and.U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table 11.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). t. 43 I r t'e Fain WORKERS COMPENSATION AND EUPLC YERS LIABILITY POLICY POLICY NUMBER: (6S1 SUE-976X516-6-02) WORKERS'COMPENSATION MASSAC.HUSETTS CONSTRUCTION CLASSIFICAT110N:PREMIUM ADJUSTMENT PROGRAM APPLICATION EAGLE EYE INSPECTION SERVICES Insured: -INC Federal Employers ID No.: Address City State Zil Policy No. (6S16UB-976X516-6-02) Effective Date i i i 9o:! Carrier THE ST. PAUL INSURANCE COMPANIES Issuing Office: Notice: Unless Code(s), total wages paid, total hours worked, calendar quertei reported are ihdicated ar-ld application is signed, it cannot be processed. Contact your agent if&,.s s;ance is-desired. f.Atil� 'f[I CI: E .. -tat - _..... :: l : - »>< 1 Excluding overtime premium pay. The foregoing is based on actual wages and hours worked, as refloged i i our payroll records, for the complete calendar quarter ending i �, "-=''� Date Signature '' Position DAYS OF I U'E: 010603 W20MIDO7 r -71 -C SOAR©QF RUILDIiNG REGUATIQNS 6 License. Sl RUCTLON SUPERVISOR Nlum1be 070029 4 s 06 Tr.no: 4020.0 RALP�H GRO;S$� `GE E SANDWICH MA 01- • _ ' Commissioner 77 • � ✓fie �o�re�nxoruuea,�l� a��/�aooac"tu� I Board of Building Regulations and Standards HOME IM,pVEMENT CONTRACTOR I Registr//a��rarrt.. 136972 23 2006 idual RALPH CROSS RALPH CROSSE 18 WOODRIDGE R " gip E.SANDWICH,MA 02537 Administrator' 4 I o�TMe r Town of Barnstable Regulatory Services grata. Thomas F.Geiler,Director Ep 1�A Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508862-4038 permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"recon construction oftran addition tooany piae�ex�sting owns occupied ion, improvement,removal,demolition,o ba&g containing at least one but not more than foot dwelling limits or to structures which are adj scent to such residence or building be done by registered contractors,with certain exceptions;along with other. 1equiren=ts. Type of Work: �/ Estimated Cost Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reasons) []Work excluded by law ❑Sob Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: UNREGISTERED OWNERS PULLING THEIR OWN PERMIT OR DEALING CONTRACTORS FOR APPLICABLEwORK DO NOT HAVE PROGRAM OR GUARANTY FUND UNDERM I42A. ACCESS TO THE ARBITRATION SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ontractor Name Registration No. Date . r OR Date Owner's Name Q:forms:homeaffidav `pFTHFlp The Town of Barnstable , 'oWP p� BARN STS MAS S. = Department of Health Safety and Environmental Services 7 e i679' �0 °'foMpy° Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: Map/Parcel: 031 687 Project Address: S0,vv\nsonS �t` I Builder: . RCjp, CrrSSe�, The following items were noted on reviewing: , MR— 0 Q rAEr-s -�o-r IeJk v,-, W1,.A ? (3) ZA to e i� S Ct�w �» dck a�.�e1� '11F� V�ou�C—I CLO r 4Z IQ A�rj J III u i vi�� �� C�btlV2 r0. fS N C�� sot C 1 ` W oo i e\ . C.o LA) v i4 Mi GS 1 C he 0 L'j N e11 0 Wo� Wt ow.$ d" y 0 Pew s r�s�e �-lr Reviewed /by:) ILL dL �b��j0 Date: /�!®S s pole i.�1l?H1�i�, _ The Commonwealth of Massachusetts Department of Industrial Accidents < 600 Washington Street Boston,Mass. .02111 Workers' Com ensation.•Insurance Affidavit-General Businesses naMe: P �' - ` taxi , 7 address: city. i state: zi : hone# �/b work site location(full address): ❑ I am.a sole.proprietor and have no one Business Type: ❑Retail❑Restaurant/Bar/Eating Establishment working in any capacity. ❑.Office❑ Sales(including Real Estate,Autos etc.) ❑I am an employer with etn to ees full& art time.): ❑Other /%�%%%%%%%/G%%%%%%%//////,% �//////�%��%�%%%//%��%%%%%�I am an r mployer providing workers'compensation for my employees working on this job., e' a o �m n-.neaie. dress. _ &Vhone..#::•` insurance. Ilk co[ I am a sole proprietor and have hired the independent contractors listed behiw who have the following workers' - compensation polices: com an name:: •` • ' • as dre�s�s _ e•1 ofione'#�• . ,..,t insurance co.. • .... ..,..... :.-•:.,;::... .:. . .•:::!:'::• -a:,,�. 130 ICY .'y C Om �C a a� , n. s e•. :i'4. n addieas:. ci rihone k insu;e` - r nee�s o: Fallure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as weII as civll penalties in the foi m of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under t ai s and penalti o erjury that the information provided above is true and correct. Signature Date �j �� '—�✓5 Print name Phone# � official use only . do not write in this area to be completed by city or town official city or town: , permit/license# ❑Building Department c ❑Licensing Board heck if immediate response is required ❑Selectmen's Office contact person: hone#• ❑Health Department , (revived Sept 2003) P ' ❑Other _CORD. r+cr�T1��[` sT'E OF LIABILITY INSURANCE _ ©P ID � - I� vN-i%ri ■d WIWI o Q o RALPH-3 � 03/15/a5 9 - — THIS,CERTIFICATE IS ISSUED X t A MATTER OF WFOMATM ONLY AND CONFERS No RI'GH`S UPON!1NE CERTIFICATE daclntyre Fay & Thayer Ins Agy ?id ERn THIS CERTIFICATE DOES_NOT AIEM,EXTEND OR 77 Accord park 15r-14� unit :1=1 _,ALTER THE COVERAGE AFFOF DED®Y THE�OLO22�€S BELOW. Satwell MA 020, b Phone:781-261-2000 Fax:7E1-::61-2099 IN§U AFFORDING COVI_RA3E (NAIL _- INSURMA:- the m6kf6lb: a D nm Group1440 INSURER -- The Ralph croseen 6astruction 18 Wooariydge Rd INSURER D: w— ' Rant Sandwl -;* MA 01-1537 j INSURER E: COVERAGES _THE POLICIES OF INSURANCE LISTED E�L01N iiMV:�E N ISSUED TO THE INSURED NAMEDA ABOVE FOR THE PCILn PERIOD RIDICA rED I rMTNSTANOM API$REOUIREMENT.T`ER14E OR CONDRWN OF ANt COKrRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIF116AW dL4Y 1 E ISSUED O.S MAY PERTARI.TH_E @DURANCE AFFORDED BY TH:POLICIES DESCRIE{ED itE"IS SUBJECT TO ALL TyE TEI"F;EXCLUSIONS ANE,CM Nnoms OF SIK:N POLICIES AGC;REGATE L6tiEITS S?t0'RTI k1AY HAbE dEEH REDUCED ECl PAID CS AY«'S ®. __- �— — LJEIu'TS LRWWM LTR TYPE OF INSURAI M POLICY h9AlE OFiTE: TE Ammm 6EMALLIASILITT' �Fj CHOCCUitiiENCE $1000000 f A 2 OMMERcmGENERALumm rr R0506989A' 03/14/05 03/14/Of � $5®A00 s(�oo�r� i s 5QO a CLAW MADE OCCUR ! 33 EXP(Ater ash D1 - — I P RsoNJlLJI A[IV INJURY $1000000_� i c:MR AL $2000000 G,F.FYL AGGREGA?E LIMIT APPLIES PER: (P IODUCTS-COt+IP>OP Ace�($10.00000 f I POLICY EC I !L� r - --— 7AUT0KOMU LIABILITY C?MOLNED SINGLE LIMIT $ Y AUTO OWNED AUTOS 1 E DOILY"WRYlerperm HEDULED AUTOS ` ! ( ) kRED AUTOS f I DOILY WAIRY $ NON-O WIED AUTOS '!ROPERT"D.4MAGE 1- 'x ii!g accident) a GARAGE LIASU Y JITO ONLY-ETA ACCIDENT S ANY AUTO )THER THAN EA ACC�S 1UT0 ONLY: A" $ D(CESSMORE LLA UAERLITY !ACH OCCURRENCE;..-_ S OCCUR CLAIMS MADE ` LEGATE? J — DEDUCTIN E BETE mnm $ IAIDR1�COMP918A'Ei6N ANS _ TORY LSIITS ER ,-` EMPLOYERS'LIABILITY EL EACH ACCIDENT S ANPRAI OIPMWEXECUTER OFFME UDEDO E.L.DISEASE-EA EMPLOYEE S jgCk describe under � ( ff E.L.=EASE-POLICY LIMIT $ OTHER I I JE OPERATIONS 1 LOCATIONS/VB IG G-':I EEIWONS ADDED BY ENDORSBRIENT I SPECIAL CERTIFICATE HOLDER _ CANCELLATION WOODSHO SWU-D ANY OF.THE ABOVE DES ID POLICM BE CANCELLEDWWOMYNE,011PIRATI11 Woods Role, bkwtt a°':i Vineyard rA7E THEREOF.TM MSWM OWN WILL BIDEMM Tom&.30 DATs wRnmm & Nantucket Steen ship NOTICE TO THE CERTIFICATE HOLDS Z NAIIIEP 1O THE LEFT,BUT FAILURE TO DO 80 SIIAL Authority IMPOSE:NO OBLIGATION OR LUMM r OF ANY IUND UPON THE INSURER.ITS AGENTS OR P.O. Box 284. Woods Hole MPi 02!43 REP"MAMES, — A D RER ETATBtTs�► ACORD L25(ZM/OS) — _ ®ACORD CORPORATION I I 780 CMR: S-TATE BOARD OF BUILDING REGULATIONS AND STANDARDS THE MASSACHU.,ET S STATE BUILDING CODE CONSUMER INFORMATION FORM-"SUNROOMS" IL chus!tts State Building Code(780 CMR,Appendix J,Section J1.1.2.3.1) The Massact isevs State BuildingC additions meet energ eff`cien standards. ode(780 CMR)includes provisions to ensure that houses and house filed as part of the bu ldin This supplemental CONSUMER INFORMATION FORM is to be g permit application a house addition witt very when a builder/contractor or homeowner,constructing/installing large percentage of glass to opaque wall,seeks to utilize a s exemption option fo,"sunroom"additions to an existing house(see C Dial effigy conservation This FORM is not n.tenc ed to Prevent a ,Appendix J,Section J1.1.2.3.1). P homeowner from selecting a`"sunroom,,of any size,configuration, orientation, form of con struction or percent glazing, but rather&only intended to assist homeowners in becoming aware of ti is dine a the in selecting and utili important energy conservation and year-round comfort considerations involved ang a"sunroom"addition. The connection of"sunroom°'structures to residential buildings ma issues due to unconn olled solar -.�!create comfort and energy consumption gain or on radiation cooling of the main house.In the selection and consi drab ns that a ion c f"sunrooms included below is anon-required,open-ended list ofproduct and design considerations that a homeowner may wish to consider before actually conshvctingrmstalling a"sunroom".It ordis recommended tha consumers carefully review..ttiese options with their designer,builder,or contractor,in er to minimize po enti:il energy consumption and/or house discomfort issues. In addition;the and reputation of the company or individuals to be rt hired a ' 9ualifications unportant considerations. PRODR AND DESIGN CONSIDERATIONS RELATED iltiTt2nnwre» • Soh r Orientation and Natural Shading TO • TyP!of Glazing • Insidating value • Sol<,r heat gain • Frame materials " • Gla dng to frame sealing and gasketiug materials/seal durability and/or weather 'gbbww of the sunroom • Ade Iual a ventilation-Operable windows and fans • APF Red Shading Systems • Inst-lation level in floors,walls,and ceilings • Pow ible Sunroom isolation from the main house via a wall and/or door or slider • Hea ing and Cooling Methods: F.tciency,Zoning and Controls Homeowner Ackno,viedgment The Massachusetts S:ate:Building Code,Section J1.1.2.3.1,requires that the ac�nropem,�,,,,, owner's agent or repr emative)aclosowl (not the of a Building Permit ONS for 3 project that includes-sunroom,additUMMNFO� g FORM ri buiidingin accordance with this equ irement,the undersigned hereby acknowle d that in this document con:erring sunroom comfort and energy conservatiion she/he has lead the information Signature of Actual I uildin � _ g Owner D-�— uv Print Name G Address of Perini Project. 7 O er ddre s(if di fe .it t an project location d ��� Owner's telephone number 682.2 780 CMR-Sixth Edition 1/19101 a� 7+ l� - .. _ CATANT , ANY-CONSTRUCTION-THA�l INCREASES L1,VINGI'SPAGE BEYOND 1200 SQ, FT_PER LEVEL MAY REQUIRE THE - -CWSTALLATION-OF ADDITIONAL SMOKE IDETkTORS. NOTE, A SEPARATE PERMIT IS REQUIRED FOR THE __.11 STA ILAT14N_OFi_SMOKE DETECTORS L.THE ELECTRICAL - - - PERMIT DOES NOT SATISFY THIS kQUIREMENT. - - "- l- . l f i t _ I r WdK ; O er _ _ _ T-1 I w � r , i I ry� ( 4 I , millNo d 1 � ' + r .2� i 1 i � i �+ � ; �ei ! �I L t •' I +� � � f � i �`� i !. ,.`� �i . ` t �-_ ` ! . i_. r" � - _ � �° i{ . j .�. ,._. _. - - ��, . .. .. _ �t _ _ ._ .. .. r . � - - , �`� 4 �'i r ,� ` � � � 1 1 ~�� F •d 4 r S �i a 4 � , f . R. .._ 1 � .. t.: __.....; - - r' a, ' ! 1 f 1 r j ' " � l _feeIT 1 3'-0©o r 1 ett5l ii-:- -r T-1 1-1 1— `� �� �. i r .. � _ � f ti r r, ! � r � y + f { E - ,� _�, _. r f f 4 1 I � y 1 y� ., T- I All } f Lo f I � 1 k f _ 1 � � ► - -} E _ _ _ �, _ _ __ _ - - - , _- - � - _ �+ -- � - - - - - - - -- � - - - - - T _ _ _ _ _ � _� �� � ,. -- - �� �- - - � - f I � _ _. _ - - � - t - � r �� - _ _ - - - � _ - - - - - - �� _ � I f { J,3 dR�ffM �JII - I 2k1Row- 5'tt 01-AC H4-4�4 4-,�� 4- — - — - - - _-�- _ I - � - _ _ _ _ _ __ � I _. � _ _ i — - — - I - i T _ _ i - - - _. _ — � _ i { � I - �.. __ � _ f...,_ i ,� T _ a,, _. .. —— —- ^r---4- - -� -- - - I _. ____ _ � �-- _, ._ _. _ _ _. r _ ! __ ._ _ .. .. .� .-. x �*_" - 4 .___ _ .� __� I _ I _. .. __ _ __ 1 - ' .. _. __. __ �. _ __. � __ .._._ L. ____._,. _. _ __. ..... __ f. _ .�,- �_.. r .. - - - . ..,_ _ .. ` _ _ � _ — — ti �.., - � - - 1 - ` - - - - 4 +'� �� - I _�_ -- -!- � -- - r- i - . _ _ _i_ ;_ _ . t � � �- _ __ (�2 50�iD i t i t f y 1-47 11I � 14 r7L HI r I - - -- i r- _ _ - � - _ _ �_ _ I i --I _ i _ i - _ - �-�_ _ - - - - - - _ ' - f- -� µ - - � _ I _.. - - .__ � .� -- i- - 4- - -- -- - - - - - _ - - - - -_ - - - - i �. - ( I _ . _ �_�_. _ _. _ �_ . - - - ;_ - , _ _ � �j i ,x R r tied. c From:Staff 508-862-6007 To:RALPH CROSSEN Date:4/5/2005 Time: 10:07:20 AM Page 2 of 2 BC CALL®2003 DESIGN REPORT - US_ Tuesday,April 05,2005 10:07 (:ED)!0UbIe 1 3/4" x 14" ERSA-I_ANi�3100 Sr Name: a on Fite Name:' ossen_ el :RB01 Address: 565 Sampson's Mill Road Descriptio :STRUCTURAL RIDG City,State,Zip:Cotuit,MA Specifier: Customer: RALPH CROSSEN Designer: Joe a era iCS0 J5 z, ER.629 Company: Shepley Wood Products Misc: 12 Standard Load 30 psf 115 psf Tnbutsry 1 t�5-00� � ' BO 2933 Ibs LL 1583 lbs DL B 1 2933 Ibs LL Y Total Horizontal Length-17-00-00 15831bs DL •versi OiNB. Gil Pt11� """"'Nc'fa! •Ir✓ Description Load Type Ref. Start S Standard Load Unf.Area End LiveTyp Value Trib. Dur. Member Type: Roof Beam Left 00-OQ-DO 17,00-0o Live Number of Spans: 1 30 psf 11-06 00 115% _srr rrar,fif i ar• Rr„ Dead 15 psf 11-06 00 90% -Rig M f anfilPyPr No Controls Summary 'Control Type Slope: Convent yp Value %Allowable Duration ^` 19193 ft ibs ° Load Case Span Location ` Neg.Moment 57.5/° 115%Tributary: 11-06-00 0 ft Ibs 2 1-Internal End Shear 3896 ibs n/a 100% Total Load Defl. U327(0.624") 35:8% 115°k 2 1-Left Live Load Defl. U504(0.405") 47�00 2 1 _ Live Load: 30 psf Max Defl. 0.624" 2 1 Dead Load: 15 62.4% 2 1 Parttlzn Load: O. pff Notes 15 �''""`'"`""'�`f fff°�!,u!,f eu f Total load deflection criteria. -rem code Minimum 1' 1240)Live load deflection criteria: == Mini VLf LfICCI.I®lu'uQf V t f rrvmximurri IGcii'detlecton crltena. f ne completeness uracvor Mini and accmum beannalenath a- -- a 4r b��rinalength for lj r n, rt2` 1 member None U Constoero Ihage, of suftab;`ty "" _ "pa .Lenglttls)=.ifear:Spanmm.enabearing+3�ir►terme ieT> 1, Y.uw; arrficauu; _ -�u ru: - vv.11_ 1 Connection Diaorair� - aac T d ',r. on tic of record Or��. st i2 i t heal representative for connection des- !Uf,J J fGY V � lU uuvl °IVICIIIV GI IT4.s5.iv JC�YV'.VG±kSv- Jf n:JISC CI(ylireol EU\tVVUI! .� uivu:Lts mu the d ]"Connectors are:i��Sh�Z%t sr ice' 14 r fine!i"Trent`instana5on Guide ° and the appricable building code, -' r a''nstaE attcn;aide or YOU* 3 I I -= , ,� rs,:please cad c 3/�° a rnuu)23 f,•88before-beginning d- oroductjnS+anahon. of r n.LCr>i3,BC FRAMER&BCIt9, BC e —� 7A dQAR_DnA,.BC QSB.RIMt 0° ,VERSA-RIM@, a i i icy v r r�.sirf..nmf -I VERSA-RIM, i "-RSA S I htAivD ` 6 I F r1PRSA-STt1DS,fiLL:1GI�STQarri ;JS'-are 3oise Cascade Cc por&_.0f,_ j ;i age 1 of 1 From:Staff 508-862-6007 To:RALPH CROSSEN Date:4/5/2005 Time: 10:07:20 AM Page 1 of 2 noisw_ BC CALC®2003 DESIGN REPORT-US Tuesday, i ,April 05 20 0510;07 ib ngle 117/8"AJSTM20 MSR ng Addition File Name: r�ssPa_DEj CC:Address: 565 Sampson's Mill Road Description PICAL FLOOR J01 JOI City,State,Zip:Cotuit,MA Specifier: Customer: RALPH CROSSEN Designer: Joe Madera Code reports: ISR-1144 Company: Shepley Wood Products Misc: Standard Load-40 psf 115 psf oc Spacing 16" 130, 1-1/2,, 453 Ibs LL 170lbs DL 131, 1-1/2" 453 Ibs LL Total Horizontal Length-17-00-00 170 Ibs DL General Data Load Summary Version: US Impenal ID Description Load Type I Ref. Start S Standard Load Unf.Area Left 00-00-00 E7-00-00 Lind vee Value OCS Member Type: Joist Dur. Number of Spans: 1 40 psf 16" 100% Left Cantilever: No Dead 15 psf 16" 900A Right Cantilever: No Controls Summary Control Type Value %Allowable Duration Slope: 0/12 Moment 2649(tabs 60.2% o Load Case Span Location OC Spacing: ` 16" Neg.Moment 0 ft Ibs 100 k 2 1-Internal End Reaction n/a 100% Repetitive: Yes 6231bs 54.5% 100% Construction Type:Glued Total Load Defl. U577(0.354") 41.6°Yo 2 1-Left Live Load Dell. L1793(0.257") fi0.5% 2 1 Live Load: 40 psf Max Defl. 0.354" 35.4% 2 1 Dead Load: 15 psf Span/Depth 17_2 n/a 2 1 Partition Load: 0 psf 1 Duration: 100 Notes Design meets Code minimum(U240)Total load deflection criteria. Disclosure Design meets User specked(11480)Live load deflection criteria. The completeness and accuracy of Design meets arbitrary(I")Maximum load deflection criteria. the input must be verified Minimum bearing length for BO is 1-1&. who would rely on the output as Minimum Minimum bearing length for B1 is 1-1/2". evidence of suitability for a Entered/Displayed Horizontal Span Length(s)=Clear Span+1/2 min.end bearing+1/2 intermediate bearing particular application. The output above is based upon building code-accepted design properties and anaW.sis methods. Installation Of BOISE engineered wood products must be in accordance with the current Installation Guide and the applicable building codes. ` To obtain an Installation Guide or if you have any questions,please call (800)232-0788 before beginning product installation. BC CALC®,BC FRAMER®,BCI®, BC RIM BOARDTu BC OSB RIM BOARD'*' BOISE GLULAM m VERSA-LAM®,VERSA-RIM®, VERSA-RIM PLUS®, ERSA-STRAND'*', LHSA-S I UU09,ALLJUI51®ana JSTm are trademarks of oise Cascade Corporation. age 1of1 From:Staff 508-862-6007 To:RALPH CROSSEN Date:7/1 312 06 5 Time:9:52:18 AM Page 2 of 4 ,. BC CALC®2003 DESIGN REPORT -US Wednesday,July 13,2005 M649 Single 11 7/8" AJST"l 20 IVISR File Name: R Crossen Dejong.BCC:J02 Job Name: Dejong Addition Description:CEILING JOIST Address: 565 Sampson's Mill Road Specifier: City,State,Zip:Cotuit,MA Designer. Joe Madera Customer. RALPH CROSSEN Company: Shepley Wood Products Code reports: ISR-1144 Misc: Standard Load-.20 psf 110 psf Oc Spacing 16, 130:1-1 r1" 333lbs LL 131, 1-1/2" 167 Ibs DL 333 ibs LL 167 Ibs.DL Total Horizontal Le gth-25-00-00 General Data' Load Summary Version:, US Impeddl.. ID Description, Load Type Ref. Start End Type Value t3C5 Our. Member T S Standard Load Unf.Area Left 0"(0-W 25-00-00 Live 20 psf 16" , 100°/6 Type: Joist Dead 10 psf 16" 90% Number of Spans: 1- Left Cantilever. No Controls Summary j Right Cantilever. No Control Type Value %Allowable Duration Load Case Span Location Slope: 0112 Moment 3125 ftabs. 71.0% 1000/0 2 1-internal OC Spacing: 16" Neg.Moment 0 fElbs nta 100% End Reaction 500 ibs " 43.7% 100% 2 1-Left Construction Type:Yes End Total Load Deft. U353(0.849") 67.Wo 2 1 Live Load Defl. U530(0.566") 90.60/0 2 1 Live Load: 20 psf Max Dell. 0.849" 84.�% 2 1 Span/Depth 25.3 Dead Load: 10 psf ►fa 1 Paxtitior�Load: *( psf Notes Duration: 100 Design meets Code minimum(Lr240)Total load deflection criteria. Disclosure Design meets User specified(U480)Live load deflection criteria. The completeness and accuracy of Design meets arbitrary(1")Maldmum load deflection criteria. the input must be verified by anyone Minimum bearing length for B is 1-1l2". who would rely on the output as Minimum bearing length for Bi is 1-ii2". evidence of suitability fora Entered/Dusplayed Horizontal Span Length(s)=Clear Span+1/2 min.end bearing+1r2 intermediate bearing particular application. The output above is based upon building code-accepted design properties and analysis methods_ Installation - of BOISE engineered wood r products must be in accordance with the current Installation Guide . and the applicable building codes_ To obtain an Installation Guide or if you have any questions,please call (800)232-0788 before beginning product installation. BC CALC®,BC FRAMER®,BCie, BC RIM BOARD"',BC OSB RIM BOARD'",BOISE GLULAM^' VERSA-LAM®,VERSA-RIM®, VERSA-RIM PLUS@, VERSA-STRAND7" VERSA-STUDS,ALLJOISTS and AJS7"are trademarks of Boise Cascade Corporation. Page 1 of 1 From:Staff 508-862-6007 To:RALPH CROSSEN Date:7/15/2005 Time:4:32:12 PM Page 2 of 2 BC CALC®2003 DESIGN REPORT US Friday,July 15,200516:31 oubl 1 3/4" x 11 7/8" ERSA-LAM®3100 SP File Name: R Crosson Dejong,BCC:F1302 Description: Address: 565 Sampson's Mill Road Specifier: City,State,Zip.Cotuit MA Designer. Joe Madera Customer: RALPH CROSSEN Company: Shepley Wood Products Code reports: ICBO 5512,NER 629 Misc: v Standard Load-30 psf 110 psf Tributary 12-04-06 BO 2220lbs LL B1 810 lbs DL 2220 lbs LL 810 lbs DL Total Horizontal Length-12-00-00 General Data Loaf Summary Version: US imperial ID, Description Load Type Ref. Start End Type, Value Trib. Dur. S Standard Load Unf-Area Left 00-00-00 12-00-00 Live 30 psf 12-04-00 1000A Member Type: Floes Beam Dead psf 12-04-00 90% Number of Spans: 1 ; Left Cantilever: No Controls Summary Right Cantilever: No Control Type Value %AlhQ?,hable Duration LoahCtie Span Location Slope: 0/1 Moment 9090 ft4bs 42.7%-, 100% 2 1-Internal Tributary: 12-04-QQ Neg.Moment 0 ft4bs Ma 10Q% End Shear 2530 lbs 31.5% 100% 2 1-Left 14 Total Load Defl. L/597(0.241") 40.2% . 2 1 Live Load Defl. U815(0.177") 44.2% 2 1 Live Load: 30 psf Max Defl. 0.241" 24.1% 2 1 Dead Load: 10 psf Notes Partition Load: 0 psf Design meets Code minimum(L/240)Total load deflection criteria. Duration: 100 Design meets Code minimum(L/360)Live load deflection criteria- Disclosure Design meets arbitrary(1")Maximum load deflection criteria. The completeness and acauacy of Minimum bearing length for 80 is 1-1/2'. Minimum bearing length for 81 is 1-1/2". the input must be verified by anyone Entered/Displayed Horizontal Span Length(s)=Clear Span+1/2 min.end bei►tn +W interme ste bean who would rely on the output as g n9 evidence of suitability fora Connection Diagram Co Connection particular application. The output above is based upon building project designprofessional of record or BOISE tecFrrtical represerttatil/-for connection design code-accepted design properties Member Koo,no side loads. and analysis methods. Installation Connectors are:16d Sinker Nail of BOISE engineered wood products must be in accordance with the current installation Guide b=3" b d and the applicable building codes- c=4" a To obtain an Installation Guide or if. d=12" you have any questions,please call (800)232-0788 before beginning product installation. C BC CALCO, FRAMER I BCI®, RIM BC RIM BOARR D"' BC OSB RIM ' BOARD-,BOISE GLULAM 61. � VERSA-LAM®,VERSA-RIM®, VERSA-RIM PLUS®, VERSA-STRAND"', ° VERSA-STUDO,ALLJOISTO and AJS TM'are trademarks of Boise Cascade Corporation: Page 1 of 1 •. r y . From:Staff W8-862a6007 To:RALPH CROSSEN Date:7/1'5l2005 Time:4:32:12 PM Page 1 of 2 BC CALC®2003 DESIGN REPORT-US Friday,July 15,200516:31 riple 1 3/4" x 18" ERSA-LAM®3100 SP i;;me: File Name: R Crossen_Dejong.BCC:FBOi °n Description: Address: 565 Sampson's Mill Road City,State,Zip:Cotuit,MA Specifier: Customer: RALPH CROSSEN Designer. Joe Madera Code reports: ICBO 5512.NER 629 Company: Shepley Wood Products Misc: Standard Loa - - d 30 sf 10 _ I P I Psf Tributary 12 04-00 BO 44401bs LL _ B1 1799lbs DL 4440 lbs LL 1799 lbs DL Total Horizontal Length-24-00-00 General Data Load Summary Version: US imperial ID Description Load Type Ref. Start End Type S Standard Load Unf.Area Left 00-00-00 24_00.00 � Value 12-0 Dur. Member Type: Floor Beam 30 psf 12-04-00 100% Number of Spans: 1 Dead 10 psf 12-04-00 90% Left Cantilever: No Controls Summary Right Cantilever-. No Control T ype Value %Allowable Duration Load Case Span Location Slope: 0112 Moment 37434 ft4bs 53.5% 100% 2 1-internal Tributary: 12-04-00 Neg.Moment O ft4bs n/a 100% End Shear 5459 tas r 29.9% 100% 2 1-Left Total Load Deft. L/379(0.761") 63.4% 2 1 ear Live Load Dell. U532(0.541") 67.7% 2 Live Load: /30 Max Dom• 0.761" 76.19�0 2 Dead load: 10 psf Notes �1 Partition Load: 0 0 Deb meets Code minimtun LP240 Total load deflection criteria. , Duration: 100 �► ( ) Design meets Code minimum(LP360)Live load deflection criteria. Disclosure Design meets arbitrary(1")Maximum load deflection criteria. The completeness and accuracy of Minimum bearing length for BO is 1-112'. the input must be verified by anyone Minimum bearing length for B1 is 1-1/2". who would rely on the output as Entered/Disptayed Horizontal Span Length(s)=Clear Span+1 Pd min.end bearing+IQintermediate bearing evidence of suitability for a Connection Diagram particular application. The output ��project deg above is based upon building fl design professional of record or BOISE technical representative for connection design code-accepted design properties Nailing sdie'due applies to both sides of the member. and analysis methods_ Installation Member has no side loads. t of BOISE engineered wood products must be in accordance Coors are:16d Sinker Nails with the current installation Guide and the applicable building codes. a —a To obtain an Installation Guide or if b=3" you have any questions,please call c=4-5/8" a ° (800)232-0788 before begirttting d=12" C. product installation. e=3" .1 ° ° BC CALC®,BC FRAMER®,BCIO, BC RIM BOARD-,BC OSB RIM BOARD-,BOISE GLULAM"m, e ° VERSA-LAM®,VERSA-RIM®, 1— VERSA-RIM PLUS@, b VERSA-STRAND"" , VERSA-STUD®,ALLJOISTO and AJS"''are trademarks of Boise Cascade Corporation. Page 1 of 1 _ - The Commonwealth of Massachusetts I� -_( Department of Industrial Accidents Office of Investigations 600 Washington Street, 2"Floor t -- Boston,Mass. 02111 elp�ti. Workers'Co m ensation Insurance Affidavit:Buildin lure in !Electrical Contractors name: address: �/ city l�r / ����1�� state: GAL. zip:x ; phone#(- work site location(full address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel ❑ 1 am a sole pro rietor and have no one working in any capacity. ❑Building Addition y. 'f,.74R'� . ... iT. `ti' x Via„ t:..F'�a:' s.i,.:,a'•'.``.: :t. �_ . am an employer providing workers' compensation for my employees working on this job. company name- i address: ci / hone#• insurance co. li � lit # I am a sole proprietor,general contr Ictor,or homeowner(circle one)and have hired the contractors listed below who have the following workers'compensation poll es: convanyBadBeS address: city: phone#: insurance co, ollc # 09"MAd company name: address: city phone#: insurance co. . olisl# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'.imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the D1A for coverage verification. 1 do hereby certify u er the pains d penalties of perjury that the information provided above is true andcorrect: S,. Signature Date �'7— ✓�� Print name' Phone# - officialnly do not write in this area to be completed by city or town official : permit/license# ❑Building Department OLicensing Board immediate response is required ❑Selectmen's Office �Aealth Department son: phone#; ❑Other 03i _ ' , FROM '� 0.j FAX N0. Nov. 13 2003i10:39AM P1 Apr-07-05 02 :55P P_01 � LbiTEIMEdICO/"YYVI ACAQM CERTIFICATE OF LIABILITY INSURANCE a 2005 rkOCUUM THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION MCS21ea InsuraACo A 4YlLalt , Inc. ONLY AND CONFERS NO RIGHTS U THE CERTIFICATE Y HOLED, THIN CBRTIPIGATE DOES NOT AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED 8Y THE POLICIRS BELOW. Osterville, Ma. 02655 5Q8-420-5011 INSURERS AFFORDING COVERAGE "Co aWSUHe0 Cripowide Enterprises, L.L.C. INAUM91A: Wentoz'n world insurance company ... INSIIRFA B: Cossamdzco insurance Company P.O. Sox 763 muxeRv Rartford Insurance Ce gpOAY Centerville, Na 02632 sua3uRv+c 06-428-4028 mu"G OWSRASEG T4 PAUCI@F,OF IN9UR/WCE LI$TFO e6LOW HAVE BEEN ISSUL9 TO THE INBUR1:17 NAME ABOW FOR THE POLICY PERIOD INDICATED.NOTWmeTANomr, ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WI CHI THIS 1O:RTIFICATS MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICHM DESCRIBED HEREIN 113 VJWF=TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF$U01 POLICIES AGUREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. _ F.JN3URAMCL., POLICYNUMIFN PDAfE ra a LIMaTS .— GENERAL LLWILITY VACH OCCURRENCE s 1 OOC:QGO X COMMERCIALGEN@Z�ALLIABILITY W MISES1p-.mTcc 000 CLANSNAADE l a l000M MEDEXPIAn can men L 5 ,000 P886905 04/28/04 04/28/05 RCRwMAI aAd mmxY s 1 000_;000 CMNkML A02MOATE s 2,000 .000. GE1PL AGMEGATE L&III APPLIES PER MODUCTS,-GOMPIOPAGO i_10000 00 POLICY j LOC AUT0MOBRELIA80.I7Y COMBINED SINOM UNIT ANVAUTO .. (4uSsa�Amrary .. ALLU MCDAUTO 90DILYINJU9Y is SCAMULM AU I OS 1Pbr eeraun) .100,000 >B HIRMALIMS 04Mb=Q081 04/20/04 04/20/05 ROD46NYIQeM1W s 300,000 NON•owaar.�Auroa PROPWY DAMA°s a 100,000 (I+a3reW>�1I) a wosLIAswry ALITOONLY-EAAC owr s ."YAUTO OTHBtTHAN � 'c d AUTOONLY: ACC 6 IEWMESRIMBRO LA LIABAITY LAcm orcuR$NCE 9 OC1rUR 0 CLML98MADE ' AG KbIATE a s OLOUGTAp.E i RETENTION 5 ! W0PAERSCONPHJSAT10NA1W nil i 1 VAKOYER$UABILIIV — ANYPAoFR1ErGR�M1NMraEou E.I.eAfgIACGDFNT S IQO OOO C ft"ICEMA"MRKIMUJ M TUX 04/14/05 04/14/06 61.DISEASE-EREJktI'LOYF, s 100,000 " vIP�dwafte""slWS �,L,DIasIeA®c-PALICY1.16dn 0 500 000 OTHLK DESCRIPTION OF OPLRATIONS I LOr-ATMU/VCHlUU f BXMAPNS ADDED WFIWOMBEMEWr/SPMIAL PROVL910NS Job Site, 565 Sampson Hill Rd Mashpee, Ma. 02649 I CFTEEATE NOW CANCELLATION MOULD ANY Nr THE ARDVE 00=890 P0I4MG 49 CANC&LLM REFORF IHE EOMATIM Ralph C7CQAIgon DATE TIW4WOF.THE ISSUING INSURER M1 tNOEAVOR TO MAR�� GAYS Wp"TrA i NM=TO INE CER FICATk HOLVM NAMR)10 THE LrFT,11ur FAILURE TO PO So SHALL MPMr NO eaumATION oR LIABiLliY a?F ANY taw UPON THE INW;MA.ITS AGENTS OR RCPNkSCNTATIVE$• AUTHOARrin lttPRrACPtMTtw ACOR025(2001/08) ACDRA aRpFIpdRATION 9 980 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map' Parcel .Permit# 9' 70 7 Health Division ^3 bP, ��� y� M� ,_` , Date Issued Conservation Division Z n� � i£ . Fee Tax Collector ,3 Phi : Applic -SYST-elLa L� INSTLED IN COMPLIANCE Treasurer WITH TITLE 5 Planning Dept. Checked in 9V IRONMFNTei ..__ TOWN REGU Date Definitive Plan Approved by Planning Board Approved By �T10Ns Historic-OKH Preservation/Hyannis Project Street Address �G, ���f vo d Village 60 v �` Owner Ji n't"-, e% o Address S Telephone c e 78- 90— '7'7-<o Permit Request QA �� 2-k 2 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation 'J Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Ltr' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full Cl 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: ❑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:Cl 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 �-� ✓`�l�r� 5�I e-G� I BUILDER INFORMATION 9/T— cQ— Name 4)d)4,M �40/14de-10 L4 G Telephone Numbed — — Address 5 G !�,�< < License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 44^ DATE 4-�2 a/d�: FOR OFFICIAL USE ONLY PER'PvIIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS'--: VILLAGE OWNER DATE OF INSPECTION: FOUNDATION 5�w� aK Sly1�j .— FRAME , INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH .,n FINAL FINAL BUILDING co cz DATE CLOSED OUT r t 0 K rn l/ ASSOCIATION PLAN NO. Ivaion n �. f i The Commonwealth of M6sachusetts Department of Industrial Accidents Office of Investigations -- 600 Washington Street, .,th Floor --- Boston,Mass. 02111 Workers'Compensation Insurance Affidavit:Buildin lumbin /Electrical Contractors > ME ., . name: address: city Ca V I state: MMa- zip: phone# work site location(full address): ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel ❑ I am a sole proprietor 'and have no one working iin[any capacity. ❑Building Addition ❑ I am an employer providing workers'compensation for my employees working on this job. company name: address: city: phone M insurance co. Dolls# memoMl ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: phone#' insurance co. volie# �p company name: address: city phone M insurance o.. . Roll# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties i the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a cop Hof this state nt be forwarded to the O of Investigations of the D1A for coverage verification. I o hereby certify u the pains a pen tie jury that the information provided above is true eejand correct/, ignature Date Z+1 [ 2-a L9 ir Print name //' Phone# ofricial use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department QLicensing Board 0 check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (rcvmd Sept 2003) .. �TMe t Town of Barn stable : • - - • . Regulatory Services Thomas F.Geiler,Director , � �g,, 36,9• amp Building Division RFD MP'� Tom Perry,Building Commissioner 200 Main Street, Hyauais,MA 02601 Fax: 508-790-6230 Office: 508-862-40S 8 Pesmitno. , . Date 4Iz J AFFIDAVIT HOME IMPROVEMENT CONTRA.CTORLAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, ied buP rovement,removal,demolition, � or construction of an addition to any pre-existing adjacent to binding containing at least one but not more than four dwelling limits or to struc es which � such residence or building be done by registered contractors,with certain exceptions,along with other requirements. �v��f P t�G Estimated Cost—k 00 Type of Work: CDO 5� ,v Address of Work: Owners Name:Date of Application: 41zX - I hereby certify that Registration is not required for the following reason(s): []Work excluded by law ❑lob Under$1,000 V 5 00' ❑Building not owner-occupied []Owner pulling own perro t Notice is hereby given that: UNRE GISTERED OWnRS.PUtLING THEIR OWN PE HOMEOIlYlDPROVEMENT�9VOItK D0 NOT HAVE CONTRACTORS FOR APPLICABLE ACCESS To T1�ARBITRATION PROGRAMOR GUARANTY'FUND UNDERMGL c.142A. -SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Cr.Name Registration No. ontraoto Date .. y12J1� . OR Date 0 is Name Q:forms:homeaffidav 1` Town of Barnstable pFZHE Tp� .. Regulatory Services ' Thomas F.Geiler,Director • • sARPisi'ABLE. � . BuRdin Division g A�fo �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE. 4 I z / o JOB LOCATION: 5-6 5 �� S number street village «HOMFowArER": /){w//4 d e_Qe5 yr Le-1 79 •- 41 o 7. 0 name home phone work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as SUU�or. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under'the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with•the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department fCo" proc es and ' ements and that he/she will comply with said procedures and require - signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger.will be required to comply with the State Building Code Section 127..0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this"section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such ` work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas it would with a licensed Supervisor. The homeowner acting as Supervisor is ultirratelyresponsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community., O:forms:hoineexempt k. ( fit EnginePn g Dept.(3rd floor) Map9� "Parcel :Q�7 :Permit# House# � y'�5-Guu:�j� •Date•Issue ` 20 "J Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) 9 _ % fh�floor)(8:30-9:30/1:00-2:00) floor/School Admin. Bldg.) SEPTIC SY3TE by Planning Board 19 INSTALLED I E f E P - A Fe�.Addre�sj �TOWN OF BARNSTABUE �N A ND NONSBuilding Permit Application �j (�(�{�{p l�� (�� CQ � r Village n Owner Li-68 E-thy e .no Z e r -)kel Address t'l-7�-y� Gov cQ t� Telephone y_-3 ®a ' - f Permit Request ., 9`- First Floor ����_ square feet Second Floor I °t I square feet V Construction Type C R C)( Estimated Project Cost $ 1 . Zoning.District Flood Plain Water Protection Lot Size , �� Grandfathered ❑Yes ❑No Dwelling Type: Single Family f� Two Family ❑ Multi-Famil�No g Highway units) Age of Existing Structure Historic House ❑Yes On Old Kin 's Hi hwa ❑Yes or Type: m4ull ❑Cra 1 ❑Walkout ❑Other Basement Finished Area(sq.ft.) "' Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing 1 New 1 Half: Existing New No.of Bedrooms: Existing _New 3— Total Room Count(not including baths): Existing j` _New First Floor Room Count Heat Type and Fuel: f gas ❑Oil ❑Electric ❑Other Central Air ❑Yes &<o Fireplaces: Existing 1 New �_ Existing wood/coal stove ❑Yes No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ff' None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes o If yes, site plan review# - Current Use Proposed Use Builder Information Name Telephone Number Address License# Home Improvement Contractor# 4 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE - BUILDING PERMIT DENIED FOR THE FOLLO NG REASON(S) N:% s ' FOR OFFICIAL USE ONLY t- PERMIT-NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION:- FOUNDATION FRAME INSULATION ~ FIREPLACE ELECTRICAL: My Gig 1— FINAL PLUMBING:. M FINAL co GAS: '+�`► FINAL FINAL BUILDING: F =crso ® ' DATE CLOSED OU A S - ASSOCIATION PLAN NO. � F t s t } . The Town of Barnstable • .Aarrs AIM • � � ,0�' Department of Health Safety and Environmental Services - Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-'6227 Ralph Crossen Fax: 508-790-6230 ( Building Commissioner For office use only Permit no. t , Date i AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: � I ja ai2L},Ja Est.Cos Address of Work: Owner's Name 1 — ['- Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied =Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR nA n r Owner's Name The Cotntnonlrealth qf 1ltassacbusctls =tv Departttuttt of Industrial.4ccitlents OffICCO laMOW9atlons 611IJ 11 ashinl ton Street �: Boston. Mass. (12111 Workers' Compensation Insurance Affidavit �hnitc•tnt information• 112MC* (n off�)�j cm,�z v ]-I n tkA `f � -1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity [! I am an employer providing workers' compensation for my employees working on this job. cnmunm• name! -- ;tdrlrccc• city- phone tf• insurn ice cn. licy# I am a sole proprietor, general contractor, M!e vie) and have hired the contractors listed below who ha the following workers' com ensation polices: com any nnine: a[lrlreSS• cir+ hone d• �I incur•tnce rn �'C� PC-)-, O_t"I Sl Q Pill f D nniicy#� n[T1�-f� ra5gq�k y cmmn•tn• n•tmc �Q 1�O11 Lx Q"s��np A l addretr � i' rity hone 0: LA incurnnce cu. I Attach aJJitianal sheet if ne�;r�iq�jiu, i•t' - '' '�i"' �1L• =•�•— -'LS.t � •'� -��ye'` .- --' Failure to secure coverage;tcd undertiection:SA of NIGL 152 can lead to the imposition of criminal penalties ofa tine up toSI.50U.UU andiur one+cars' imprisonment as as civil penalties in the form of a STOP WORK ORDER and a tine of 5100.00 a day against me. 1 understand that a copy of this matcatrttt mac be funvardcd to the omcc of Investigations of the DIA for coverage verification. 1 do berebi•ce ' i under t/te pal d penalties of periun•that the information provided above is true aitd cv e(cCt. Si=nature Oate v ' Print name d Phone rr JN-Y hII-3L I SL1 ofliciai use univ do not write in this area to be completed by city or town official city or town: permit/license it r'itluilding Department t Licensing Huard - Cri cheek if immediate response is required 0seleetmen'x Umcc ►• �. C311caith Department contact person: phone ; nother �. iniormation an . Massachusetts General Laws chapter 152 section '_5 requires all employers to provide workers compensation for their employees. As duotcd from the"la%%`. an emplitree is defined as even, person in the service of another under anv contract of hire 'express or implied. oral or written. An etttpinrer is defined as an individual. partnership, association. corporation or other legal entity. or anv two or more . the foregoiitg cngagcd in a Joint enterprise. and including the legal representatives of a deceased emplover, or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the dwellinm, house of another who employs persons to do maintenance , construction or repair wort: on such dwelling hour jr on the :rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. .AGL chapter I52 section 25 also states that even- state or local licensing agency sliall %ilithhold the issuance or ••enelyal of a license or permit to operate a business or to construct buildings in the commonyealth for any ippiicant who has not produced acceptable evidence of compliance with the insurance coverage required. %dditionaily. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the .erformanee of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha :.-en presented to the contracting authority. --� --• - pp►icants ti lease fill in the workers' compensation affidavit completely,.by checking the box that applies to your situation and 1pplying company names. address and phone numbers as all affidavits may be submitted to the Department of idustrial Accidents for confirmation of insurance coverage. Also be sure to sibn and date the affidavit. The "fidavit should be returned to the city or town that the application for the permit or license is being requested. it the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required obtain a %vorkers' compensation police. please call the Department at the number listed below. ity or Towns ease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of affidavit for you to fill out in the event the Office of Investi?ations has to contact you regarding the applicant. Pleas sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to _ Department by mail or FAX unless other arrangements have been made. I'",e Office of Investirations would like to thank you in advance for you cooperation and should you have any questions. rase do not hesitate to _give us a call. . e Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents _ rf _ - office of Investigations 600 Washinbton Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (6I7) 7274900 a.xt. .406, 409 or 375 n 3y' l� - ii i S .tiaa-, i� j7� � � , • ILI - i IT Z , 14 i Nsuloriod -Al cZa Zx/a . . r - > l r • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE q JOB. LOCATION 2 (o; C"�n,+�, Number Street address Section of town � 11 HOMEOWNER" Name Home phone Work phone PRESENT MAILING ADDRESSrn City town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sy who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"- shall submit to the Building Official on a form accaptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes .responsibility for compliance with the Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands ..the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will co ly with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction Supervisors, Section 2. 15),. , This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "Owner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/Ater responsibilities, man communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. TOWN OF BARNSTABLE Permit No. .....�2g...... . BUILDING DEPARTMENT I 'A"" I TOWN OFFICE BUILDING Cash 7 M� HYANNIS,MASS.02601 Bond X CERTIFICATE OF USE AND OCCUPANCY Issued to Bruce Kelly Address Lot #36, 565 Sampson' s Mill Road, Cotuit, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ... ....October..l.9.'. 19......9. ...... / ...... . .... aC J Building Inspector 0, Y Wp.,°` •e TOWN OF BARNSTABLE BUILDING DEPARTMENT = saaasr : TOWN OFFICE BUILDING riva erg' i67q' �� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: 4 An Occupancy Permit has beenissued for the building authorized by BuildingPermit .........d..............................,.:............................................................... ...................» _ issuedto ............,..._................. ............: .. . .......»................................................................................... ... .................................... h' Please release the performance bond. rTOWN OF BARNSTABLE, MASSACHUSE I L D!N G, P R M 1 A Q3` -081l� Q DATE ,?U1V n PERMIT'.NO APPLICANT ROSE BU ld $ Ccy ADDRESS 'Cenerv� lle Win: (NO ) ry (STREET) (CONTR S LICENSE) PERMIT TO:_ Build Dw.e111AQ ( ) STORY stnQl@ Fame l� "DWQ1 NUMBER OF (TYPE OF IMPROVEMENT) -, NO ;;.NUMB (PROPOSED USE),;., t AT (LOCATION) Lot #36/ 5:65 °S$m SOn'B M3.11 ROad`, COtu�♦ 20NING,. , (No ) DISTRLCT - (STREET) BETWEEN ` (CROSS STREET) AND i. . (CROSS STREET) SUBDIVISION COT BLOCK LOT . _. SIZE. FBUILDING,IS TO BE FT, WIDE BY FT. LONG BY FT. IN. HEIGHT AND SHALL CONFORM..IN CONSTRUCTI TO TYPE USE.GROUP BASEMENT.WALLS,'OR''FOUNDATION x:, - [1. (TYPE) REMARKS: Sewa1Qe+ #92 365,4 AREA OR: 952 sq ft r ME • ♦ t Y PERMIT+ k F VOLU ESTIMATEb COST t a a b� ICUSIC/SQUARE•FEET) rsFEE OWNER BruCe Kelly 625 ;2 T it enuey Ostery 7� X/IDDRESS' i@. BUILDING DEPf. By, �LF t L `NRESTRICTION-5... PPLICANT FROM THE CONDITION: MINIMUM OF THREE CALL INSPECTIO NS •A NS R APPROVED SQUIRED FOR OVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE ALL CONSTRUCTION WORK; CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL ELECTRICAL, PLUMBING AND MEMBERS(READY TO LATH). QUIRED,SUCH BUILDING SHALL NOT BE,OCCUPIED UNTIL 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 015 A fy 2 3 I HEATING INSPECTION APPROVALS ENGINES G DE AjXME T z 2 r a3- r BOARD OF LTH SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W! TOR HAS APPROVED THE PROCEED UNTIL LL BECOME NULL AND VOID IF S STAGES CO NSTRUCTION GES W NST OF WORK RUCTI IS N ON CONSTRUCTION. OT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED EP THIS CARD CAN N PERMIT IS ISSUED AS NOTED ABOVE, ARRANGED FOR BY TELEPHONE OR WRITTEN NOTIFICATION. 3 t ti0. p ��p z LOT 35 F#o �9 W 88.1 i n�$ Sao LOT 25 � o F� LOT 24 LOT 36 �6, e LOT 23 ISO, D bo .o, LOT 44 s AP��D�l � LOT 22 LOT 43 LOT 42 FLOOD ZONE "C"_ FO UNDA TION CERTIFICA TION RES ZONE. " TO AN:COTUIT SCALE.•1"=80 PL.REF.•L. C. 36319—D ELEV I CERTIFY THAT THE ABOVE . FOUNDATION IS LOCATED ON YANKEE SURVEY CONSULTANTS THE GROUND AS SHOWN, AND ���tN of � s9c 143 ROUTE 149 P. 0. BOX 265 ITS POSITION�QE�----- . PAuL ys - MARSTONS MILLS, MASS. 02648 CONFORM TO THE ZONING LAW b MER THEW y TEL: 428—0055 9 No. 32o98 Q FAX 420-5553 SETBACK REQUIREMENTS OF ��F _ZuR NSTABLE --- ------ �s�Daac �allos°Q JOB A UL A. �MERITHEW DATE. 7�22192 NUMBER50178 20 M/H 70P O/'/OUADANIC/A' WAYA{7I cvvAw - 2'LIYSR OF OROYIND EL CONCRl78 tVPATte ILS sm" OR A:IAI)DfA6 40 A!11Y i.. PJ1�I l/I'PER R. vc I'SC/®VL8'40 P.Y.Q .,••' ' 'PIPE-AP2L 6oX _ 7ZOI!A'6 Pf/CHEL ;I lMVBRl Ile• PA6CA9f OR • _ IlIl�7 �� 1 .. - G911WP tl i1i11U1t I pyVXej J A7MALAW ""X fAAr ° 9 I'NO 1- 0 'VACANT LOTS 7 7— {GOAD � ss�A, o 'gb70�� � BOTTOM OF T65T HOLE OR USCS PROBABLE WATER TABLE EL=____ - MILL /b qg_-� - - OBSERVED WATER TABLEEla--_— Mp5oNs L / 125.00' y PROFILE OF sA i . _ �8� 'SEWAGE DISPOSAL SYSTEM 384.14' NOT TO SCALE — 1 • - yD'!'CP I o ® k ALL ELEVATIONS ASSUMED N 273'20p, O 00, - II91.0 zQ ee PB----- - SOIL LOG ,. WITNESSED BY: �L'RRY DUNNING A DATE dZVZ22 DATE 1W-Z-AZ HEAL 13/LN77CYR TEST HOLE 1 TEST HOLE 2 70wv Cr BARNSPABLE () �d EL= 77.2 EL= 77.3 .. BILL LIEBERMAN`PE TOPSOIL O,_1 SUBSOIL PFRCOLAY70N RATE_5�_MIN./INCH DESIGN DATA: NUMBER OF BEDR0014S 3 c _ - COTUIT _ COTUIT GARBAGE DISPOSAL NONE SAND SAND TOTAL'ESTIMATED FLOW - CPO _ _ (__GAL/BR/DAY z_BR) SEPTIC TANK CAPACITY lip LEACHING AREA REQUIREMENTS NO WATER ENCOUNTERED SMEWALL AREA CAL/S.F. 9 gA SOS BOTTOM AREA CAL/S/F 33 GS LEACHLNC CAPACITY (BOTTOM R SIDEWALL) _ CAL BOTTOM �SIDE YMOAVA.5 = 471 N GENERAL NOTES RESERVE LEACROVC CAPACITY ___ CAL 1. 7XIS PLAN IS FOR INSTALLATION OF NEW SEPTIC. PROJECT LOCE10H• ASS LOT B7 519 4� 2. PLAN REFERENCE L G PLAN 36319-D CO7UlS/OA S IEILL ROAD 3 THIS PLAN IS FOR D.67ALLA77ON/REPAIR OF SEP77C SYSTEM AND NOT 7V BE USED FOR SURVEYING OR ZONING PURPOSES APPLICANT. DICK SCHRAEDER 4. ALL WRKWANSHIP AND MATERIALS SHALL CONFORM TO D.ER 20 ROSS BUILDING CO. 7TTLE 5 AND 771E 2V#N OF BARNSTABLE RULES AND REGULATIONS P.O. BOX 309 \ !OR THE SUBSURFACE DISPOSAL OF SEWAGE CEN7`ERVILLE; MA. IOCYIS 5. ALL COVER 7O SANITARY UNITS SHALL BE BROUGHT TO WITHlN YANKEE SURVEY CONSULTANTS !P'OF FW6HED GRADE G E=,WC AND FDVAL GRADES SHALL REMAIN ESSENZiA/LY THE P.O. BOX 265, 143 ROUTE 149 SAME UNLESS NOTED BY FINAL CON7t7URS ,�{ MARS7ONS MILLS, At 0264E 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE' H (SOB) 42B-00 OF WMNYTAXORM H-10 LOADING UNLESS 7NEY ARE UNDER �N OR MAW 10'OF DRIVES OR PARFmVC AREAS H--20 LOADING 2 /"m 4d A 7/2/92 APPRO VED: BOARD OF HEALTH SHALL BE USED UNDER OR WITXOV/O'OF DRIVES OR PARIUN2 UNLESS NOTED.- 8. ANY MASONRY UNITS USED 7O BRING COVERS TO GRADE SHALL REV BE MORTARED IN PLACE DA TE 8. NO DETERMIM42TON HAS BEEN MADE AS iO COMPLIANCE WITH LOB NO. AGENT DEEDED OR ZONING REGULATIONS OWNER/APPLICANT N 7C1 LOCATION MAP 50/7B SHEEP / OF 1 OBTAIN SUCH DE7ERAMM27ON FROM APPROPRIATE AUTHORITY. PER LLJ ------- _ I ON S > is - � ROLT GLCJe'fic/.1 _ � _ {LIGHT SIDE BLE-l4TIGIJ _ ' 12L 4' . J Li ►)IsNF-o tip rr u.. I Is w.ns IT- 1I - .1`�1.-- oz • , - •. � ;mil r I q�L. _ jouu Ari-w PL1 Iwo . �.¢ININL__ .'KTGNeN - A II ,/�yl soK sw,w.rK.-\ � _ _ _ 4 I • I j ?-I '�— .._ & I . .`�. T tw, ,,' !j _ -"}:#'"„'ter.:+. • �� ..I ---------- ----'- _N _. _ 1•u/Nsu ru.4 Y; y -� u_lun 4_7 1 _ ... ....._. .. ........ .. ...... ......_....___....__._....-__._.__._...._._..__........_ Assessor's office(1st Floor): / Assessor's map.and lot number 0 ho 7 i Tw t SEP Conservation r "�— rN '�'M p's Board of Health T3rd floor):` �'(�to Sewage Permit number 14rgr2 a: Engineering Department(3rd floor): .a� � 3o.v House number Definitive Plan Approved by Planning Board APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2k P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO NS RUC; 5/ A,iyt I l ��U tMC a � TYPE OF.CONSTRUCTION _ 0�GO p l K14 y1 �U I,U T— 19 j 1/ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Zo T 3 6 11,4&SPSs012s, 1-- � f S,? r sill r.��So l wl►t.c_ !S 0. C?vi i Proposed Use S 64-E FAoA I L Zoning District �S/ �e471 n Fire District 7- Name of Owner ,Vtz Address 3z- -7-tll pn /qvL 7Cr? jjw-e y Name of Builder OAS 4)6-- C9+M A Address ()•O, (80k C-g�E',�Vj Name of Architect Wa Address /�✓� Number of Rooms Foundation wl,2L.D C� r-- Exterior wl-/i Roofing 11SPI' c i�1 Floors 'yAGdOWOOD `b V AIJL- animaUT driterior Heating 9'k)— )I�j G-A.9 Plumbing y x L'0 D£ Fireplace ES Approximate Cost /S� GGO Area Dia ra.��oo,�Lot and Building with Dimensions Fee G�z���l'a� G Z19 O � 1 Z9g 3 c{o OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above nstruction. s VIA I- s C, Ross f � Name �Ut(,61 61 l Construction Supervisor's License �.�6gWti KELLY, BRUCE No 35229 Permit For 11 Story Single Family Dwelling J, _ Location Lot #36', 565 Sampson ' s Mill Road' CCotuit Owner -Bruce ,Kelly 1 + Type of Construction., Frame i X / Plot f ° Lot Pe"rmit Granted July 28 , 19 92 1 I Date of Inspection 19 { +^ ; a Com let Z_ `19 cola9 1 i i1 t south side 12, O„ stems c base: 12'x12'deck of 1'W" on 16" ctr - - - - 6pc 8"sonotube premix cement base 2x4 construction in walls 2x6 roofrafters on 16'ctr with 6:12 pitch . � _______ • ___� � _ _ 2p home made. 30".doors with plexiglass top light 1 pc 30' screen door oposite double doors ' orientation of 87 joists 4pc storm windows in'shed #` a 2' 0° shed roof 1/2 CDX with asphalt shingles Y -- shed sheething rough cut pine board grade - - - -- -- - 4,_O U 61.011 6'-0" s 92' 0" 6'0" 6'x6' sloping ramp COTUIT STK 20 f-) n (FNDJ 'rE j ?RUDE -o 9 C.B. 00US 509"4 ON, SA 820"E - LOT 35 1Nq'2.13 ASSESSORS LOT 39-86 )PAS SEPTIC SYSTEA! `� PROPOSED 6 O� LOCUS MAP C.B A'AS DRAA71/FROM THE (FND) 9nwN OF BARNSTABLE ''� ADDITIONS SEPTrC rNSTALLERS CARD PLAN REF. 36319D PROPOSED G ` ASSESSORS' MAP. 39—87� PROPOSED DECK � � ZONING: ADDITION ZONING:�_ RF SETB •ACKS.• 30 — 15 —15 CB r DEED REF 148344 l2 (END PLOT PLAN OF LAND ON � LOT 25 • LOCATED AT o� LOT 36 ASSESSORS 565 SAMPSONS MILL ROAD ASSESSORS �, ASSESSORS • LOT 39-94 ` LOT 39-146 �' COTUIT, MA. LOT 39-87 AREA=90780�S.F. PREPARED FOR- AAA & PA ULA DE JONG LOT 24 ='�P�s `v F r, ss10 i MARCH 28, 2005 N,• ' Y 0��a Q�G CFO Gn r 3y ASSESSORS o STEPHE ; REV LOT 39—93 0 " DOYLE N i ASSESSORS ao ti Jac 01 Q ,` REV LOT 39-145 N 10°�� REV- LOT 2. v ©� YANKEE LAND SURVEYORS ASSESSORS & CONSULTANTS GRAPHIC SCALE LOT 22 _ ,LOT 7-92 50 P.O. BOX 265 o zs so goo UNIT 1, 40 INDUSTRY ROAD ASSESSORS ASSESSORS MARSTONS MILLS, MA 02648 TEL• 508-428-0055 FAX 508-420-5553 LOT 39-144 LOT 39-91 {.` 1 inch 50 ft. °Y I SHEET 1 OF 1 JOB ,¢! 53855 JF r .L COTUIT STW E 28 (FND) R�QT �d poAl) I PRUDE b I ILL C a OCUS 50914 o cr Off. AM + O„ _ON 'LOT 35 y ,2 Nq 2'13 V. °s ` ASSESSORS Q LOT 39-86 565 0 �` , 1Q.o "� LOCUS MAP �-- 1 THE SEPTIC SYSTEM - �� •PROPOSED WAS DRA JOW FROM THE C.S M ON OF BARNSTABLE � � ADDITIONS � PLAN REF36319D (FND) SEPTIC INSTALLERS CARD ��• �A 'phOPO ED ' .. ASSESSORS MAP- 39—87 DECK" ZONING: "RF" PROPOSED > ADDITION SETBACKS: 30 —15 —15 C.B. i DEED REF 148344 (FND PLOT PLAN OF LAND to LOT 25 LOCATED AT LOT 36 ASSESSORS 565 SAMPSONS MILL ROAD ASSESSORS �, ASSESSORS LOT 39—94 CO T UIT, MA. LOT 39-146 LOT 39-87 9� AREA=90780fS.F. 339 r PREPARED FOR. WILLIAM & PA ULA DE JONG LOT 24 ►►►�a4tH r���sS �• MARCH 28, 2005 ASSESSORS f <o PSTEPHEN ^+. REV J.19 LOT 39 93 DOYLE N REV- ASSESSORS ® � = - 0 ,Q REV LOT 39-145 R0 s �y~�• LOT 23 ��••� YANKEE LAND SURVEYORS i o—5,.,"�D--p i ASSESSORS & CONSULTANTS LOT 39-9I 50 GRAPHIC SCALE ,00 P.O. BOX 265 LOT 22 UNIT 1, 40 INDUSTRY ROAD MARSTONS MILLS, MA 02648 ASSESSORS ASSESSORS TEL• 508—428—0055 FAX 508—420-5553 LOT 39-144 LOT 39-91 1 inch = 50 ft. SHEET I OF I JOB ,¢! 53855 JF ' 1