HomeMy WebLinkAbout1666 SANTUIT-NEWTOWN ROAD llvlolp Csar��vif ,lYu�riown
�� �- --
Town of Barnstable _ Building
. .•. 'Po'st-This Card So;That rt is Uisitile From:ahe Street •A e roued,Plans Must be Re#arced on Job and this Card Must be Kept J
* ABi.C. • �a .',' �
ib Posted Untit Finallnspection Has Been Made
" Where"a.Certificate;of Oceu anc. �s Re „ured,such Buildxmg shall Notbe0e"copied,until a Final Inspection has been made ��l jjll�
Permit No. B-19-1867 Applicant Name: ASKEW, DOUGLASJ& LYNNE
Approvals
Date Issued: 06/07/2019 Current Use: Structure
Permit Type: Building-Deck Expiration Date: 12/07/2019 Foundation:
Location: 1666 SANTUIT-NEWTOWN ROAD,COTUIT Map/Lot. 024-035 Zoning District: RF Sheathing:
Owner on Record: ASKEW,DOUGLAS J&LYNNE _ Contrjactor:hlame;` Framing: 1
X y
Address: 15 JULIE LANE f Contractor-License,. 2
COTUIT, MA 02635 Est Project Cost: $ 10,000.00
= Chimney:
Description: BUILD NEW DECK ON EXISTING RESIDENTIAL DWELLING NJ Permit Fee: $ 110.00
Insulation:
Fe;e Paid", $ 110.00
Project Review Req: _ 6/7/2019 Final:Da te (a f
Plumbing/Gas
A R `� � � Rough Plumbing:
Building Official
m Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within sox months after;issuance.
All work authorized by this permit shall conform to the approved application�and the approved construction documents for which this permit has been granted. Rough Gas:
.1_ - ? € , �
All construction,alterations and changes of use of any building and str ores shall be in compliance with the local zoning by laws and codes.
This permit shall be displayed in a location clearly visible from access street o�roadand shall be maintained open for public inspection for the entire duration of the Final Gas:
work until the completion of the same. r
w Electrical
The Certificate of Occupancy will not be issued until all applicable signatures bye, a Bui in&and Fire Officials are;provided on this^:permit.
41,
Minimum of Five Call Inspections Required for All Construction Work � � Service:
1.Foundation or Footing 4, ,
2.Sheathing Inspection
N... W, r Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final:
5.Prior to Covering Structural Members(Frame Inspection)
Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations.
Work shall not proceed until the Inspector has approved the various stages of construction. Health
"Persons contracting with unregistered contractors do not have access to the guaranty find" (as set forth in MGL c.142A). Final;
Building plans are to be available on site Fire Department
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
Application Number. s
Mnes ' ' ✓ ��163 Permit Fee........ Other Fee........................
9. a��� �F�
0 Total Fee Paid.....-l'.).......... ....................................... ......
TOWN OF BARNST E Permit Approval by... .�..:...:...... On.....�1.?.11q........
BUILDING PERAHT
Map........................................Parcel.............0.�....1................. — --�
APPLICATION
Section 1 — Owner's Information and Project Location
Project Address_�(o( p <S�I�V IZ ,L c[I� gOhD Village �' v-'4-
Owners Name e—,7-)d()�—` 1�
Owners Legal Address_ 15 J
d; City C®7VIt State /�� Zip
Owners Cell# 60 73 7 7SI,5 E-mail 6,QV91)64=IdZ 0— 1hA10*11 .eW4
Section 2 —Use of Structure
Use (Troup ❑ Commercial Structure over 35,000 cubic feet ,
❑- Commercial Structure under 35,000 cubic feet
LEI Single/Two Family Dwelling
Section 3 —Type of Permit
❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use
❑ Demo/(entire structure) ❑ F' 'sh Basement ElFamily/Amnesty El Fire Alarm
Rebuild Deck Apartment El Sprinkler System
❑ Addition ❑ Retaining wall ❑ Solar
❑ Renovation ❑ Pool ❑ Insulation
Other—Specify
Section 4 - Work Description
Application Number.....................................................
Section 5—Detail
Cost of Proposed Constructio Square Footage of Project -54 A�7
Age of Structure 90 AS Dig Safe Number 42
#Of Bedrooms Existing , 3 _ Total#Of Bedrooms (proposed)
110 MPH Wind Zone Compliance Method MA Checklist WFCM Checklist Design
gn
Section 6—Project
S e t Specifics
J P
❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors
❑ Plumbing El ' Fire Suppression
❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom
I
Water Supply Public ❑ Private
Sewage Disposal ❑ Municipal ❑ On Site
Historic District ❑ Hyannis Historic District ❑ Old Kings Highway
Debris Disposal F ili � U/kl d ❑ 2 Facility: `►��ti� � I am using a crane Yes No
tY�%� � g
Section 7—Flood Zone
Flood Zone Designation
Within or adjacent to a wetland, coastal bank? Yes ❑ No
Section 8—Zoning Information
Zoning District Proposed Use Lot Area Sq. Ft.
Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site)
Setbacks Front Yard Required Proposed
Rear Yard Required Proposed
Side Yard Required Proposed
Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No
T act 52
Application Number...........................................
Section 9= Construction Supervisor
Name Telephone Number
Address City. State Zip
License Number License Type Expiration Date
Contractors Email Cell#
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license.
Signature Date
Section 10—Home Improvement Contractor
Name Telephone Number
Address City State Zip
Registration Number Expiration Date
I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780
CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and
documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C...
( . Signature Date
j Section 11 —Home Owners License Exemption
Home Owners Name: e 4,-.
Telephone Number Sa—73 7- O/S Cell or Work Number
I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780
CMR the(tio7
etts State Building Code. I understandthe construction inspection procedures,specific inspections and
documenuire by 780 CMR and the To ofB ble.
Signatu Date
APPLICANT SIGNATURE
Signature . Date
Print Namf��jy Telephone Number�=�37 _&S
E-mail permit to:
Section 12—Department Sign-Offs
Health Department ❑ Zoning Board(if required) ❑
Historic District ❑ Site Plan Review(if required) ❑
Fire Department ❑
Conservation ❑
For commercial work,please take your plans directly to the fire department for approval.
Section 13— Owner's Authorization
i
as Owner of the subject property hereby
authorize to act on my behalf, in all
matters relative to work authorized by this building permit application for:
(Address of j ob)
Signature of Owner date
Print Name
r
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations r
606 Washington Street
Boston,MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit:Builders/ContractorsXlectricians/Plumbers
A licant Information Please Print Legibly
Name(Business/Organization/Individualf: C�� tbn
Address: ),5 V LAC l-tW e 'O-(7/V CO7Vi�
City/State/Zip: oov`L 14,q o)6# Phone#: S08`737-11615
Are you an employer?Check the appropriate bor. 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 mein any capacity. employees and have workers'
[No workers' comp.irmrrance COS.insurance•
t
9. Building addition
5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their I L .Plumb' r
3. I am a homeowner doing all work ❑ �repairs or additionsP.
myself[No workers'comp. right of exemption per MGL 12.❑Ro f repairs
in��nce ram-)t c. 152,§1(4),and have no
employees.[No workers' 13.�er .. t/ .
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors most submit a new affidavit indicating such
tContractom that check this box must attached an additional sheet showing the name of the subcontractors 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 thepolicy and job 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 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 her y c under the pains and pe of eTuy that the information provided above is true and correct
Si Date:
Phone#: _ 3 -
Ofjtclal use only. Do not write in this area,to be completed by city or town gfjicial
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#:
Information and Instructions
Massachusetts General Laws chapter 152 requi all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person iri the service of another under any contract of hare,
express or implied,oral or written.".
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,.§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit toyoperate 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,MOIL 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 insuance
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
necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
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 enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permit(license number which will be used as a reference number. In addition,an applicant
that must submit multiple pe alit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially 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 commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of In&m tW Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel.#617=727-4900 ext 406 or 1-877-MASSAFB
Revised 4-2407 Fax#617-727-7749
wwwxam.gov/dia
Town of-Barnstable *Permit# �� q?
Regulatory Services lee6manthsfromif,�ues e
s ,
yMASS. '$ Richard V..Sea%Director
qjp s639. �1m ®R j7
n tea+ Building Division Ifi�� Ql..
Paul Roma,Building Commissioner . EJ
200 Main Street,Hyannis,MA 02601 MAY 2 6 2017
www.town bamstable ma us
Office: 508-862-4038 TOWN � t2a_
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
QC;
Not Valid without Red X-Press Imprint
Map/parcel Number Q 6, 14/- — - I
Property �-
Address'
�sidential Value of Work$ UC Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
WRe-side
❑ Replacement Windows/doors/sliders.U-Value {maximum.32)#of windows
#of doors:
*where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License 8z Construction Supervisors License is
SIGNATURE:
Q NWHILESTORMSUilding permit forms\02RESS.doc
01/25/17
t
The CowrA rrweakh ofAfassrfdrap!i s
est qfrn&shidAcddadg .
OfTwe of ITI IiS
Boston,MA 02M
ir fDFV1-v.i1 MMgvP1dz l
WGrkerS' CrnUPensadan Insm-ance Af ffihrv4L SmIdersJC�ntra Mechic*=„cPlmnhers
APPF=imt hfarrmiai ngn Please Pit Lev
Nm= _
Addrem
,
�itgf Phoe
Am you an employer?:Checkthe appropriate ba m Type of project(requimd)=
L❑ I am a employes with 4 ❑I am a g contmctcr=d I 6. [:]New oonsftucEog
emplayew(fall anUor pa t--h=).* 1mve hisedffie sub-cankmcft rs
2.❑ I am a sale proprietor arpartaer- listed on the attached sheer 7- ❑Reaodeliqg,
SUP and have no employees These sub-cauftadorc have $. ❑Demolition
wadingr for me i a any capacdy e-=Floyees andhave Nodwre 9_.El Enilcliag sddifrau
;i,�a„� c ssu�$
�o•�va3mcs coup_ a °�' a
- lik Electrical
d-]. 5.[] We are a corporafma and its ❑ repairs or adEg=
3.M ama homemxner doing all vrack Flvmbingrepaus or adclifiamtigbt s ,
�€[No wo �+comp- of as per Hf{� 17❑B.oafrepaas
inwra=erequired.]i c:=§lM andwehavemo ,,./
���-ENG wadome 13-I.�0gLer
cow imsamnee mquaed_]
•mayapp� $�stc5er�s6oz l�nnsta]safiIlo tfiesecBnabeiosysha �fie¢wo�Tceis'c®p—s peTirgiz5=sa a «
amgrs�o submit 9m K stet'ttxt=tlaio�tagwa¢f ttadBaea}�atrts d� at3�st submit anewa�dmgit ixrdie>maa�+r7�
s"a� $t 6 �t eberlt lids bmc mast sdtar7�ttaatidifi®sl shedsbaRiagti�eaameof the sub cch�and st>fet
--' arheshs arrant these elvt�e
• .Ift�.sob-c�r,ad�6hasx�pis�t5eymasrpxsnide-stiffi•uv�'�P-p�F�� -
-Taman
a:ripIrar iliatis prQui3ing�rorkers'cotaperesatiatt gisriraricanr arc empf �eex $eTativ is�TiapaTicF rind jeFi szta
irl�arnxaiiaa,
Imsnrance Companybbme:
"Pnficy�ar.self--im.€I�.e.•� • I�piaatiaaDate:
Job Sif�Address: COIStafe r _
Affach:t-capy of fm warl`ers,ca1apeusa4i4apn1icy decEasation Sage(A owing the poEcy ansaI er and expiration lots). .
Failure to secme coveeage as rejuimdunder SetE=25A of MJM a l5-7 can lead to ffie imposifioa Qf crimissal peuaHaes of a
fine up to$UOD OD sadl'or oiu yearimpdso> as weft asrivil penalties is the fatm of a STOP WORK ORDMand a f-me
of np#t. DO a clay a the violafflr. Be adrisec€'tiaat a�P'Y of tlsis•stat�*�+��srsagbe farararded in tlse f}ffice of •
Imresti a#ions of Me MA far fiLs=mw coveragm ism_
I da�-�y escfrfy rurdgr t#e pains and psrla�s er�Frrp that$is irr,{artrsatyurrpts��dabat�a ig tr=acid c arrrect
Date.
Phofne
OVdd use rrref Do gust Arita in ff6 am,€rr be wmplated by cep artopra afficiaL
City or Tam= PermitUcense;9
IssnkgA ffim*(tideone):
L Bo=d of 3T—T+h y Buffirng Department 3.Iowa C(sk 4L Eleefnml Iuspertor S.Phnnbmg hcspector
Coact Person: Monet:
.+e11 `■1` •� .■:./[� �•Its w l .;een ■•wF [■ .1 ■ ■- •••l■erF r•1■tIt:1t .■/U. UI iI ■ v1te11 •• -
w.ul �..Y. . ■u■. �.• •r. n ••■n1..■
' ■ �.u • •� A •au■�. _ _n u n n.r ._■ a.+F nl. _R.wr:n n■ .0 •far-n a\ u ■it� •r- gun' a _u• •.• n ■■11 "
• rt- [• •■e• w■1:;�■ ■■ � •lne r■ter ■Irw- _I■■ ■. 1■.■t■_ to _
a • ■ ■ ram- • :n u u u■. •_. ■■rw■■1• _AR•w.n\I. a •li■. rnr■ rnu \• u_ ..nu ••�w :.•. •r ie
■..■� rj _ •• 1■r■ ■.■ ■. 1■ •■ ■■sl ■•.■■ its � J■.I ■■■r■l.. =1t. ••■• .�Y\:+ it.l �f■■ ■1 ■■ ■ r■11•:■.1 • ■■
■ -' It' ■•■ - • :t.■�1 ••■• .@Niglio• ..+t.•1■ It \. ■■.t1■fare.■t r •I• ■ ■1 ■•1■ \1 ■.■! •••■. ■1• ■ 1
• •■1■ r/ J ••e■• u I e1 ■ls• :■/.•I l.i..■■1 t ■• t l ■■ .�r:t■ • ■ .■ w■Ie• ■•e■r11 • e.�!■■�• ■• ■ _n ■111 •
J Ci ■c■.Ir
. . _ t _ \ �f ■ •- ■■11 ■/ •.- .■I- ■ IlY■1�..V. ■ ■1 .•■A■ 1 Y ■ i• . ■■ • Ir f. r■ 111■. ■
• ■ t • - ■■ ■ •■ I �■ - ■Y. ■ - - 1 ii1 r ■ ■ 11 • ■r 711 ■.. e■ 1\ - I _
■ ■ tI 1 1
■■ u u■_ 1 u ■.n•� Y r� r_ ■� .iti■. u .141 u■•' lit •• .n • t1 •• n.• I■\\ Y m ■
r 11■�1 fan• _n rta e ■ _r In ls .:�Qn.0.n r ■ /•/ •'Ur. mn :rr.�■r• - •r■r • •lup J. In e■- u Yn .0
�■■n rn a■1■. • n t:fa.� ■. ■��+■ • w.au.• fa i■ rum .rm_ .falls•r/
ill •■l in t■.\r■ olsu:■ rn•■ Ji/■_ 1 r\mn r ■ r■► ,ten: u •■/w ■.1 ■.■ u •.u vIn_fa•• at■ 1
■• .Uen _rlU ■-1■e r _e.1 w`A =n■ ■I•1■ el\■ls.:1 _ •■ ••Ils ■■ I r� ■1■.rni •
1 BE :■■ e/■■ ■'A Y.. 1 ■I.n■.■■■w •l lest■i■ ■ e '_■ ■■.fF■IU
■1 ill\.1 • •.t ■• •■ ■■ �•ne i■ ■• ..=■• ••.■.•:�F r.[t■Is:,e Y:■\Il ■■ ■t :■e
1J/1■ • •� ■• .\■■l �■ t -■ ■■_I ■■1 ■■t. 'I e1 • • ■11■[1U�• ls ls �r1. ■t■rrl • •.1■ 1■.
- . •�u1, u w ■tun.n n1 ■ n n .n► re• _ . ■ ■■ u _ . ■t • ■ �■ " -m■_ M. G■..• 1• ■
• -/•.\■�\ ■■ • Mt •I n' ■ \■_l \e- _I.I t✓.L•le nl ie' .�rtte • ..+■ .- 1■_ .■e w r.■ . • i■ �r•.t ■et r■1 •
V �■ell �■ 1. ■.Y...I _ •••■.•.IF
U .r r.■ BUR 17\t ■ ■l ■: _■■ • /�.\Is �.1 \IIe_ ■e' •• • ■ •• :I
\nu re _■■■ ■• 1 • � r=1 i■ �i.-I m reI ie faun. u■-■ • •-
■/ .. _.■ .n uuu. u■ a _t.a ■•n�r_n m"
• � • ls i._I a _ri■\.•1 .nun ■ =ls■ .nn1�\ �_,. �■ �:+■:■ to w.l ■_ n •• ■-• /.•• J i\ ••uuu
• ■\ .trr/_ '1 1• '•1 1• ill a■/ ■■ i1 •�■ ■■ 0■■r . \■•w■•-1■■I■ ■ n r•■Ir '■■ •■ ■ n_ ■• •I■■ r■
` � . e n i1 u n I a\ae A w■ - n In ■r ••u 1 l \ ■1,�\ - Ir w. ■tuu•M ■ _..n■■ :n _.• r:u
• •r.1 ■.tee •• ■Ue111 ■71 f.\.• 1 e■■ r:\■■: ■n �•
■\.1 ■t ■A /■t. r■ ■1■Is •�Ut n rr■ d1 I w:t■Is 11 .er J •re
•• n •11>oJ■�■ 1 e.rw _■ a■. ne\. •• 1u \ wR i _t\ ru ■■ t ••nr .l •►:■ t n
w • •
•■• • ls .t1■■. I ls. \- •..+e 1 [■w.l rnu■�\ ■1 a nr.r�•. I i\ wl ■I ls^■ ls. •' ■1 • • e 1■ it"
_n/ w:n. n •• le. ■ i■\. I •■ is W uuec ■.+m � n rrt .� 1
• ne.• 1 lsn • 01�■ •u �
• r.0 • \-rne 1 1■ :•.■ a .n •\vu w • r•n a\r .•r_ •rum
•. • i■ • ■ •..�.•.n ■•
•l■ ••.• • .a ■■ It_n •■t n .\'.n r u •.n q•■rr:e■.n .0■ e.■ t ■t ■. • .0 ■ oil
all
r. r•-1 u.r■ _ ■fat n e r.• uuu■
r- •+tr�cr f_r ••_�_ u r �:ww rIr r�r,■1.
i�� �.I.w\t1■t• try■ f ��
t�
Town of Barnstable
Regulatory Services
s"XAM ' t Richard V.Scali,Director
►` ' Building Division.
Paul Roma,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 509-862-403 8 Fax: 508-190-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
L ,as Owner of the subject property
hereby authorize to act on-my beb4
in all matters relative to work authorized by this budding permit application for:
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final
inspections are perfomaed and accepted.
t
Signature-of Owner Signature of Applicant
Print Name Print Name
Date
Q:F0R1&:0VNEUERNIISSI0NP001S ,
Town of Barnstable
Regulatory Services
Richard V.Scab,Director
Building Division
awmvsresre. = Paul Roma,Building Commissioner
KABIL
039�. ��� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 - Fax: 508-790-6230
HOME_OWNER LICENSE EXEMPTION
i ,�/_ / Please Print
DATE: 6 (�(v n I ,'1
.JOB LOCATION: I ��& / y�I��wn �'J �"
number s 0,3P0 ,L1qqo��eH �OMEOWNER7: baak�
name . home pon # work phone#
CURRENT MAILING ADDRESS: '5 I t r/�' ►a as (.�l..l-�cVP--
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFINMON 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 hermit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
pro s requireme and he/she will comply with said procedures and requirements. "
Sitgature 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
ro ided that if the homeowner
1 -Licensing o f construction Supervisors);provided from the provisions of this section(Section 109. .1 g P � P
P
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 person as it would with a licensed Supervisor. The homeowner acting as Supervisor is
ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
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.
Q:\WPFMES\FORMS\building permit fomss\EXPRESS.doc
0620/16
4 49 Herring Pond Road Buzzards Bay,MA 02532 P.5o8-888-i74o F.5o8-833-3377
aK 3�tx�Is ��
Resolution .
E N E R G Y
March 25, 2013
Thomas Perry, CBO
Town of Barnstable
Building Division r
200 Main Street
Hyannis, MA. 02601
N
Re: Insulation permitsCo
Dear Mrf Perry: ,!
This affidavit is to certi ►
certify that all work completed for msula ,ion w rk �..
at 1666 Santuit-Newtown, Cot uit has been inspected by a certif ied
Building Performance Institute(BPI) Inspector.
All work performed meets or exceeds Federal and State requirement.
Sincerely,
Lisa M. Haglof,
Executive Office Coordinator
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel oa 5:'� Application # [ '
Health Division Date Issued
Conservation Division Application FeeO3S
Planning Dept. Permit Fee 1
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address
Village D't�u 1
Owner C._ Address �� �� — New �,�. (20a
Telephone
Permit Request Sea k k 0 C
III t
a
ICQS w a S
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation a ` Construction Type
Lot Size - ( Q.Cv'p 5 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family LAY Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ®-Mo On Old King's Highway: ❑Yes 21Vo
Basement Type: a'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 Coqt —a
Heat Type and Fuel: ❑ Gas Oil ❑ Electric ❑ Other _ Z`
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stQye: 00 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: :;:J
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name Telephone Number
Address License #
Home Improvement Contractor# ` Z
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
d
J
FOR OFFICIAL USE ONLY
�= APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
j
ADDRESS VILLAGE
OWNER
r`
DATE OF INSPECTION:
FOUNDATION
' FRAME f
INSULATION
FIREPLACE
ELECTRICAL. ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
t ASSOCIATION PLAN NO. # -_
r
The Commonwealth of Massachusetts
Department of Industrial Accidents
ro Office of Investigations
600 Washington Street
Boston, MA 02111
7 H
www.mass.gov/dia
Worker's compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Inforimation Please Print Legibly
Name (Business/Organization/Individual): Agso CEO 21/'
Address: / eV`✓ 0!5 Dg
City/State/Zip: ✓'c4 S Q o Phone#: S6 F5,—
Are you an a ployer?Check the appropriate box: Type of project(required):
I. I am a employer with 4.❑ I am a general contractor and I have �6. ❑ New construction
employees(full and/or part-time).* hired the sub-contractors listed on 7. ❑ Remodeling
the attached sheet.$
2. ❑ I am a sole proprietor or partnership These sub-contractors have 8• ❑ Demolition
and have no employees working for employees and have workers' comp. 9. ❑ Building addition
me in any capacity..[No workers' insurance.$ 10. ❑ Electrical repairs or additions
comp insurance required.] 5.❑ We are a corporation and its 11. Plumbing repairs or additions
officers have exercised their right of ❑
3. ❑ I am a homeowner doing all work exemption per MGL c. 152§ (4),and 12. ❑�ther
irs
myself. [No workers' comp. we have no employees. [No workers' 13.
insurance required.] t comp.insurance required.] w e a T I 1 ui
Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees.If
the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site
information.
Insurance Company Name: SM11 1 Y� Usl✓1C'tS .J—V1SU✓�kCQ / -SPVJC� �✓IC
Policy#or Self-ins.Lic.#:WC-2 3 1 S— 3 70.Sd 3 O�� Expiration Date: _ 01
Job Site Address:�n& )A Vl'1 t.r`4 0-40,4J44 `- — City/State/Zip: t
Attach a copy of the workers'compensation.policy declaration p ge(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a 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 n
y Z
under the pa' s a enalties f perju that the information provided above is true and correct.
Signature: 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
FDATE(MMIDDIYYYY)
Act o® CERTIFICATE OF LIABILITY INSURANCE
9,7,20„
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER
. THIS
HE POLICIES
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TAUT AUTHORIZED
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5),
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER SMALL BUSINESS INS AGCY INC CONTACT NAME: —
542 MAIN STREET PHONE 508 795-0635- A/c No: 508 798-501)8
WORCESTER, MA 016150022 E-MAIL ADDRESS:
INSURER(S AFFORDING COVERAGE NAIC 9
INSURER A: Liberty Mutual Grou —
INSURED INSURER B
RESOLUTION ENERGY INC INSURER C:
49 HERRING POND RD INSURER D:
BUZZARDS BAY MA 02532
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 11075950 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
IS SUBJECT TO ALL THE TERMS
CERTIFICATE,MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ,
EXCLUSIONS.AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ADDL SUBR - .POLICY EFF POLICY EXP LIMITS
TN-SR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY YYY MM/DD/Y -
LTR
EACH OCCURRENCE $
GENERAL LIABILITY DAMAGE TO RENTED
PREMISES Ea occurrence $
COMMERCIAL GENERAL LIABILITY
" MED EXP(Any one person) $
CLAIMS-MADE 0OCCUR -
PERSONAL 8 ADV.INJURY $
GENERAL AGGREGATE $
PRODUCTS-COMP/OP AGG $
GEN'L AGGREGATE LIMIT APPLIES PER: $
PRO-
POLICY LOC COMBINED SINGLE LIMIT
¢adenl $
Ea a '
AUTOMOBILE LIABILITY -
- BODILY INJURY(Per person) $
ANY AUTO 4 - BODILY INJURY(Per accident) $ -
ALL OWNED 8 SCHEDULED
PROPERTY DAMAGE
AUTOS
AUTOS NON-OWNED Per accident $
HIRED AUTOS AUTOS
$
EACH OCCURRENCE $
UMBRELLA LIAR OCCUR -
AGGREGATE $
EXCESS LIAB CLAIMS-MADE
DED RETENTION$ $
WC STATU- 0 -
A WORKERS COMPENSATION WC2-31S-370523-041 - 9/2/2011 9/2/2012 TORY LIMITS � -
AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $ 500000
ANY PRO PRIETOR/PARTN ERlEXECUTIVE r�i I N 1 A
OFFICER/MEMBER EXOLUDED7 ( IN 1 E.L.DISEASE-EA EMPLOYEE $
(Mandatory In NH)
If y ,descrlbe under
es E.L.DISEASE-POLICY LIMIT $ 500000
OEas IPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule;tf more space Is requlred)
Workers Compensation Insurance: Part One of the policy applies only to the Workers Compensation taw of the State of MA
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
HOUSING ASSISTANCE CORP THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
460 WEST MAIN STREET
HYANNIS MA 02601-3698 .a - AUTHORIZED REPRESENTATIVE -
Jeff Eldrldge
1988-201.0 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of'ACORD '
CERT NO.: 11075950 CLIENT CODE: 1558558 Deb Deroche. ` 9/7/2Di1 7:15:27 A71 Page 1 of 1
This certificate cancels and supersedes ALL previously issued certificates.
91te -Cammowweald
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 171991
tf_ r 1 Type: Corporation
Expiration: 5/9/2014 Tr# 224975
RESOLUTION ENERGY, INC. "f
JEFFREY TONELLOrY� -:f
P.O. BOX 1516 A
--. 't
SAGAMORE BEACH, MA 02562 �Wr
Update Address and return card.Mark reason for change.
Address Renewal Employment Lost Card
DPS-CA1 Co 50M•04/04-G101216
�o ✓1ze �anvrnaruueai� o�'✓�aac�u�aeetta
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration:, �r171991 Type: Office of Consumer Affairs and Business Regulation
Expiration:____5'/9/-20.14 Corporation 10 Park Plaza-Suite 5170
Boston,MA 02116
RESOLUTION ENERGY-3. INC s;4
JEFFREY TONEL'L0 __
-
43 FIELD WOOD DRIVE_'= ear---
SAGAMORE BEACH�MA;02562' Undersecretary t lid w' out signature
l
R ,
+ - —1U4-G101< 4 .
?=>. i`1a�sachu,ctt< - Dcparlilicnt nl Puhlic S'alc
J/xe PanUr,zo�zusealc/z. o.' �tacrc/zuaeCYa 1
• �` � Board of Buil(lin_ Rc�ulatinn� and St:ultla!
Off-ice of Consumer Affairs& Business Regulation Construction Supervisor License
• HOME IMPROVEMENT CONTRACTOR
Registration:,.=�162158 Type: License: CS 53202
Expiration:_-.`1%26%:2013 Individual
# c\ j —
JEFFREY R.TONELLO JEFFREY R TONELLO
PO BOX 1516
JEFFREY TONELLO::.:., SAGAMORE BEACH, MA 02562
60 STATE RD.
SAGAMORE BEACH,'MAi02562 Undersecretary e—
��� Expiration: 7/14/2013
( uuui>•i„nc,. Trn:, 21481
Failure to possess a current edition of the
' Massachusetts State Building Code
is cause for revocation of this license.
/
/'l_. Refer to: WWW.Mass.Gvv/DPS
.' �,`
P
SOUSING 460 'vJest Ma-in Street
Hyann;s, MZ,_ 02 601-3 698
r ' ASSISTANCE ENERGYs i,priE REPR�R
%f T (508) 790-7105 F (508) 790-
' CORPORATION 2425
HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE:
' ^, ri L_ E),UT-A-N-DSIGN-T-H+S-FORW-F-Y-G.0 An - _
THEAPPLICANT HOMEOWNER.
I hereby consent to and agreethat weatherization work may be .
done by the Weatherization Program of H ousing Assistance Corporation (herein after referred as
"Agen " ) on the property)ocated at:
Theweatherization work donewill be based on programmatic priorities and availability of funding and
it may inciude all or some of the following measures:
Weather-stripping& caulking of windowsand doors, insulation of attics, sidewalis& basements, attic
and other ventilation measures and possibly replacement of badly deteriorated windows. In
consideration of the weatherization work to be done at my home I agree to the following:
1. 1 give permisgonto.the"Agency" its agents and employer✓sto travel onto oracrosssaid
property with such equipment and materials as maybe necessary to perform weatherization
work on said property.
2. The H ousing Assi stance Corporation reservestheright to inspect thefuel or utility bill for the
weatherized unit on an ongoing basisfor no morethan five(5) years after theweatherization
work is completed.
I have read the provisions of this eement as listed and f eely give my consent.
Home Owner: (Sgnature)
Date.
Agent: (signature) _
Date
HAC approved Weatherization Company :
All Cape Energy, Caliber Building&Remodeling, Cape Cod Insulation, Cape Save, Creswell Construction,
Frontier Energy Solutions, ahr&Sons, Peter Smith Resolution Ewer Rock Solid Consixuction
-----------------------
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel O� S� Application #
Health Division Date Issued
Conservation Division Application FeA
Planning Dept. r Permit Fee 5� J
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation /Hyannis
r Project Street Address S AJ 0 J-1-6W 1 R 0a
Village
t rr I
Owner 01- S Ke%AJ Address
Telephone 7Ct
�
Permit Request e-p v 0�116 vN S2c� �, U q C
__ II
iLKA
Square feet: 1 st floor: existing proposed - 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation a Construction Type
Lot Size $ G Q CY%P S Grandfathered: O Yes ❑ No If.yes, attach supporting documentation.
Dwelling Type: Single Family — Two Family,, L1 Multi-Family (# units)
r, Age of Existing Structure Historic.House: ❑Yes 9<o On.Old King's Highway: ❑Yes Cho
f Basement Type: a-Kull ❑ 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: 3 existing new
Total Room Count (not including baths)• existing new First Floor Room Count
Heat Type and Fuel: 0 Gas 0" '
/
yp Oil ❑ Electric ❑ Other
Central Air: ❑Yes 0 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: 0 existing ❑ new ', size _Shed; ❑ existing ❑'new size _ Other: w
Zoning Board of Appeal8'Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use ' ' • _ .. Proposed Use
APPLICANT INFORMATION
(BUILDER,OR HOMEOWNER) ,.
f
L Name Telephone Number.
` Address License #
!! Home Improvement Contractor#
�I Worker's Compensation #
,f
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
j
i
IIII; SIGNATURE DATE
I'
LL The Commonwealth of Massachusetts `
Department of Industrial Accidents
Office of Investigations
600 :Washington Street
w ..
�4a Boston, MA 02111
r�,M gyav` www.mass.gov%dia
Worker's compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): 2 j 2✓'
Ad ress: � e—^Vl I 0 a -A,A Oei
City/State/Zip: Qq � - Phone#: 0 �-7,V0
Are�you an a ployer? Check the appropriate box:
Type of project(required):
4 6. New construction
c and I have
I. e I er with � ❑ I am a general contractor a
Iama m o g ❑
P Y
employees(full and/or part-time).* hired the sub-contractors listed on 7. :❑ Remodeling
the attached sheet.$
2• ❑ I am a sole proprietor or partnership These sub-contractors have 8• ❑ Demolition
and have no employees working for employees and have workers' comp. 9. '❑Building addition
me in any capacity..[No workers' insurance.$ 10. ❑ Electrical repairs or additions
comp insurance required.] 5.D We area corporation and its
officers 1-1.have exercised their right of' .❑ Plumbing repairs or additions
3 ❑ I am ahomeowner doing all work exemption per MG1✓c. 152§(4),and 12. ❑�th6
irs
myself. [No workers' comp. we have no employees.,[No workers' 13.
insurance required.] t comp.insurance required.]
w.e a � ev l za
*Any applicant that checks box#1 must also fill out the section below showing their.workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such..
$Contractors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees.If
the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job.site'
information.
Insurance Company Name: Sm � 0S*1✓iefs � SU�a►�ce eWC4 �4
Policy#or Self-ins.Lic.#:WC; "3 I S- 3 70.So7.3 OV/ Expiration Date:
Job Site Address: �I2�—s�Q� � �M � ��►` ` 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 MGUc. 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 Zby ce under the pa' s a enalties f perju that the information provided above is true and correct.
Signature: 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#:
r
.,�rU4-G10tnu - ,
� INl:tssachust:tt. - Ucparini nt III Puhlit: Saf(
9X. &.11 uuealC/r. a�',-,mot oac/auaeCra ry Board of Buil(liw-, Rc ulatinnS and S[atil.kU
\ Office of Consumer Affairs& Business Regulation
Construction Supervisor License
HOME IMPROVEMENT CONTRACTOR
Registration:, -2162158 Type: License: CS 53202
Expiration;--_'1%26:I;20.13 Individual
��iz
JEFFREY R.TONELLQ'?"''�;' =::::: JEFFREY R TONELLO
PO BOX 1516
JEFFREY TONELLO` SAGAMORE BEACH, MA 02562
60 STATE RD. %c•
SAGAMORE BEACH,MA 02562 Undersecretarye—
� ��� Expiration: 7/14/2013
('rnnnnaci mcr Tr-m 21481
Failure to possess a current edition of the
Massachusetts State Building Code
is cause for revocation of this license.
!1 lJ
' � Refer to: WWW.Mass.Gov/DPS
of'THE Town of Barnstable *Permit#
Regulatory Servicesee h
6 mont from' ue
RARxsresLE,MAM
* —
9c6 1639. `0� Thomas F.Geiler,Director
•erEO MA't A ,
Building Division Dw
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www:town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
of Valid without Red X-Press Imprint
Map/parcel Number
Property Address 41
❑Residential Value of Work imum fee of$35:00 for work under$6000.00
i
Owner's Name&Address / G%9
Contractor's Name - Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
WRIT
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor APR 25 2012
LEI am the Homeowner
❑ I have Worker's Compensation Insurance
TOWN OF BARNSTABLE
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit:
Permit Request(check box).
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-s'( e
#of doors
Replacement Windows/doors/sliders.U-Value/ ���"(maximum.35)#of windows Cl/
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation;etc.
***Note: Property Owner must sign Property.Owner Letter of Permission:
copy of the Home Improvement Contractors License&Construction Supervisors License is
re4uired.
SIGNATURE:
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC
Revised 051811
The C&Mmmrn ealt4 of Maysackrueth
D eparhnent of Indushi4l Accide
Of we of Investigadons
606 Washh4ton,Street
Boston,M4 02111
wwks,,.mamgvvldia
Workers'Compensation Insurance Affidavits Builtit=rs/Con ns/Plumbers
Apipheant InformutioII - - Please Print •b'
Name(I3 i7ztion(I&idual}:
Address:
QtylSta&Zip-- Phone ikQ
Are you an employer?'Meek Ae appropriate boa: T of project r
4. I am a contractor and I Type P 7 ( end}:
• I.❑ I a�a employer with ❑ �� 6. Idew canatrt�tian
employees(full and/or gait-time).* have hired the sub-contwtors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
These;sub-contractors have
ship and have no employees8- ❑Demolition . .
working for me in any capacity. employees and have wodaws'
o workers'camp.inswance comp insuranMI 9. ❑Budding addition
3.arequired-] 5. ❑ We area corporation and its 1 -❑Electrical repairs car additions
Iam a homeowner doing all work _ officers have emucised heir 11.E]Plumbing repairs or additions
myself:[No workers"cornP- right of exemption per MGL 12.❑Roof repairs
tnsura^+•e requfted.]T c.152,§1(4h and we havens
employees.[No workers' 13.❑'Other
comp.ms umace required]
7 aPRh,.fat cLeds box#1 mast also fill out*e:section below showing lives workere�P�ao p�Y
13ameownes svba subm A this affidsw indicating they are doing all work amd then hie outside conuxton mmst submit a new afdm indicating such.
k8nuactors that check thisbOX thust at dud and additional sheet smowing the amae of the sub-cars:zod state whe&u arum those entities bane
employees. If the cab-contractors ham emplayee%they must provide iheir workers'comp•Policy number.
I am an eanploysr that is provi`diarg"Orikers'congmnsaiion.insu ance fanny engAayy ea Bdow is the policy and job sAtr
information.
Insurance:Company Name:
Policy#or Self ins.Lic.#: Expiration Date:
Job Site Address: Gitylstatdzip:
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 a 152 can lead to the imposition of criminal penalties of a
fine up to$1;500.00 and/or one-year isonmenta as well as civil penalties in the form of a STOP WORK ORDER anda Ere
of up to$250_DO a day against the i iolator. Be advised drat it copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verificatican_
I do hereby catrh;�j� the pains anti orf' irry�that the injorrrQatio npratRd above is andporrect.
Si tare: Date-
tl
Phone#: e<_4
0,fficiatuse only. Do not wrke in this area,to be completed by city or town affieiar
City or Town: PermitIAkense#
Issuing Anthority(circle one)..
1.Board of Health 2.Bing Department 3.City(rown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other '
Contact Person: Phone#•
6
HE Town of Barnstable
• r
Regulatory Services
Thomas F.Geiler,Director
1639. Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: (/ r
JOB LOCATION:
pn*r street tlage
"HOMEOWNER": At/2 C�
name ome phone# r p nnee I
CURRENT MAILING ADDRESS: /
city/town state - zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
. The unde igned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
proce s dzequirements aud4at he/§he will comply with said procedures and requirements.
Sign 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 person as it would with a licensed Supervisor. The homeowner acting as Supervisor is
ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
of this issue is a form currently used by several towns. You may care t amend and adopt such a form/eertification for use in
your community.
Q:\WPFILES\FORMS\building permit forms\ENPRESS.doc
Revised 051811
i Q�
fi
• iARNS['ABI.Fw •
Town of Barnstable
ArFD MA't A
Regulatory Services
Thomas F.Geiler,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038. Fax: 508-790-6230
Property Owner Must
Cornplete and Sign This Section
If Using A Builder
h , as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
QAWPHLESTORMSUilding permit forms\EXPRESS.doc
Revised 051811
pp THE T� Town. of Barnstable # �0 7 a.� (p
QY k Expires 6 months o issu date
' `Regulatory Services}
Fee
MASS
16 -Thomas F. Geiler,Director.
39„ �
Building Division
. Toni Perry, CBO; Building Commissioner
200 Main Street,Hyannis,MA 02601'
www.town.bamstable.ma us
Office: 508-862-4038 Fax: 5`08-790-6230
EXPRESS PERMIT APPLICATION--- RESMENTIALL ONLY
�.( o['Valid without Red X Press Imprint`•
Map/parcel Number 0� \
Property Address
71 Residential Value of Work O�✓�� l� Aflnimum fee of$35.00 for work.under$6000 00* -
Owner's Name&Address A-1 �� A' M r Eu J
Contractor's Name
Telephone Number
Home Improvement Contractor License#(if applicable) g.
Construction Supervisor's License#(if applicable) nP -
❑Workman's Compensation Insurance 32012e
Check one: FEB,
2
❑ I am a sole proprietor
�I am the Homeowner .
❑ I have Worker's Compensation Insurance - TOWN ®E BARNSTABl.E
Insurance Company Name
Workman's Comp. Policy
Copy of Insurance.Compliance Certificate must accompany,each peruut.
Permit Request(check box)
.w_
Y(Re-roof(stripping old shingles).All construction debris will be taken to
❑Re-roof(not stripping, Going-over. existing layers of roof) ~
Re-side
' #of doors
❑ .Replacement Windows/doors/sIiders, U-Value (maximum 44)#of windows:
*where required: Issuance of this permit does not exempt corilpliance with other town department regulations,i.e.Historic,Conservation etc.
***Note: Property Owner,must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License & Construction Supervisors.License is
wired. ,
n ,
[GsATU&E: G`
IWPFIL.ESIFORMSIbuildingpermit fnrrnslEXPAESS.doe ;
:vised 070110
r
¢ The Commonwealth of Massachusetts
Department of Industrial Accidents.
Office of Investigations
d 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): IGI.A NS ICE U
Address: I r•� � If ''�'�
sty/State/Zip:---000(+ MA 6oA63 Phone.#: Y -' 33
Are you an employer? Check the appropriate box: . Type of project(required)-.
1.❑ I am a em to er with 4, 0 I am a general contractor and I
p Y �" "- 6. ❑New construction .
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have' g, ❑Demolition
workingfor me in an capacity. employees and have workers'
Y P tY• 9. ❑Building addition
[No workers'comp.insurance comp,insurance.
5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
r giyred.]--� ;^
am a-homeowner doing all work officers have exercised their HE Plumbing repairs or additions'
myself. [No workers' comp. right of exemption per MGL , 12.F 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:
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 must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
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 numbW and expiration date).
Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as,civil penalties in the form of a STOP WORK ORDER and a 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 certify er the pains a penalties of perjury that the information provided above is true and correct.
Si ature: Dater pia
Phone#:
Official use only. Do not write in this area,to be completed by city or town official,
s
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#:
t
4
Information and Instructions
employees.
Massachusetts General Laws chapter 152 requires all employers to provide workers. compensation for their p. yees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-conti•actor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
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 enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"I:he 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 fo any business or commercial venture
(i.e. a dog license or permit to bum 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 Con monwealth of Massachusetts
Department of Industrial Acoldents
Office of In estigatims
600 Washington Street
Boston,MA 02.111
TO.##6.17-72.7-4900 ext.406 or 1-877-MASSAFB
Revised 11-22-06 Fax#617-727-7749
www.mass.govldia
_ r
a, �T"ET Town of Barnstable
Regulatory Services -
sAxrtsrasr.L, Thomas F.Geiler,Director
MASS.
i659. Building Division
AFOMA'Ip b.
Tom Perry,Building Commissioner:
200 Main Street, Hyannis,MA 02601
www:town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
CDA
n er street village
`_—'HOMEOWNER
name J / home phone# k ph ne#
"CURRENT MAILING ADDRESS:
city/town s ate zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six 0-units or less and
to allow homeowners to engage an individual for hire who does not possess a license
,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on.a form acceptable to the Building Official,that he/she shall be .
responsible for all such work performed under the building permit'(Section 109.1.1)
The undersigned"homeowner"assumes responsibility foi compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.' ,
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum s ction proced s and requirements and that he/she will comply with said procedures and
require ; .
Signature of Homeowner
Approval of Building Official J'
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. :
1 • HOMEOWNER'S EXEMPTION
The Code states.that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1 Licensing of construction Supervisors);.provided that if the homeowner engages a persons)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 person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, ;
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by,
several towns. You may care t amend and adopt such a form/certification for use in your community.
i
Q:forms:homeexempt
i
�T Town of Barnstable
Regulatory Services "
a�xxsrnBtE.
MASS. �, Thomas F.Geiler,Director
16.19.
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign Thi ection
If Using A B ' der
s
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work a o ' ed by this.building mit
gPer
(Address of Job)
**Pool fences a d alarms are the responsibility o. he applicant. Pools
are not to be filled nce is installed and pools are not to be
utilized until all final inspections are performed and accepted.
Signature of Owner Signature of Applicant
Print Name Print Name
Date
Q:FORM&OWNERPERMSSIONPOOLS
_ r f.y_.�,•. _ ..''ram._ _
Assessor's office(1st'Floor): // ,/ �
Assessor's map and lot number RIo 7 Q ��J ok YWE To
Board of Health(3rd floor): d� „
Sewage Permit number
Z IMUSTALLL i
Engineering Department(3rd floor): � G �1S �° rasa
House number /
; ° i639. ®�
Definitive Plan Approved by Planning Board 19 o waY d•
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN , OF - BARNSTABLE
BULLDING INSPECTOR .
APPLICATION FOR PERMIT TO
TYPE OF CONSTRUCTION
19 _
TO THE INSPECTOR OF BUILDINGS:
The.undersigned hereby applies for ermit according to the following information:
Location
Proposed Use
Zoning District Fire District OeI7 v 1 7—
Name of Owner 01-DAM 'fib 0_2 A Address SCTVrU1T
Name of Builder Address
Name of Architect �' Address
Number of Rooms Foundation
Exterior Roofing
Floors Interior
Heating Plumbing
Fireplace Approximate Cost r�P/Or
Area
Diagram of Lot and Building with Dimensions Fee
C � P ) -Z- �
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 cons uction.
Name
Construction Supervisor's License
' SOUZA, ALDINA
h1
No 33197 Permit For Raze Garage +
Accessory Dwelling
r= Location •16 6 6 Newtown Road
Cotult 1
Jw, Owner Aldina Souza
Type of Construction Frame
.ti
Rw...
Plot Lot
r. f
Permit Granted September 11 , 19 89
Date of Inspection 19
Date Completed 19
CA
r'.. i
uJI
mw
LLJ
14-
o z
c� Q �G,+ SAk i v`i — owl C T®+,�c H
z o m I Ca
z o
m -----------------
N
Barnstable Bldg De t.
r PAv t'c. Apprmed by'- ---
a
0
• S
� N i
l
-- - - -- 1
mA
IL
IU
Oratbe"drG
TIF
fy.VgT '
f it La
vs nis
7p,PliaAL
Gam.
_ r
3�' ®" J.4e2
r ,
x T -WAL- tVA;'p�
x — _ .
or
5 tMT�ewt' .1oe�t° '�' S
- I
tt. sAt%cmt> p.ciz .w
6�I�t 11
i
\\ I
\ I\
\
\ 1
\to PARCEL 035
0.86 Acres 1
\ 22
\ X 1
\
\ / n
\
\
0241034 '� 0241036
n/f ` — — ' n/f
Savoia ' Is i3 Opp Dishman
fF.risting ces
to b.P.,uped�ut gyp \ \
andRenuwel l W 1 \
�bd���NM�i n-soXk� I ,
d L5 i
,O N(�� 15�10 Gallon
tot Se tic Tank „ q i
i
,1d�p CO Exist.
7`� 3 Bed \ \
_- Dwelling 6
76-0
F. Fl• \ I = \
77.44'
LEGEND 72.6 '
U:Pole 0 I \ --72
Exist. Spot Elev............. 3543
_ - -
Exist. Contour................ 35.9 - - - SANTUIT - NEWTOWN ROAD
Prop. Spot Elev..............
Prop. Contour................. 36
Setback Dimension........ 13' i2
Perc. Test Location........
Prop. Water Service...... —bb�—
REVISION DATE I BY
73U 3' i'Et ooa� - tAd `N CF R4 S�a�r
SITE & SEWAGE
Y n �o NQRMAN
Melissa� �
GROSSMANm
DISPOSAL PLAN N CIVIL
y _ M°
ant � #1666 SANTUIT-NEWTOWN RD A�.� 9fGiSTE�``�
BARNSTABLE, MA
APPLICANT: ENGINEER: NORMAN
Re s �a Aldina Souza Norman Grossman, PE, RLS `�No.S 27�N J �'yc. 1666 Santuit-Newtown Rd. 10 Marsh View Road
Santuit, MA 02635 East Falmouth, MA. 02536
LOCUS ,MAP ,
SCALE : 1 - 2000 508-548-1920
MAP SEC PAR LOT FLOOD ZONE ELEV. MAP SCALE DATE I SHEET NO.1 PLAN NO.
024 035 C --- 250001 0021 D 1"= 30' MAR. 03, 2004 1 OF 2 H-795-1