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0020 CHILDS STREET
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Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Add ess Village Owner1 Address Telephone 71 Permit Request &4� M Square feet: 1 st floor: existing proposed 2nd floor: existing_ proposed Total new Zoning District Flood Plain rrGroundwater Overlay Project Valuationp° Construction Type� `�( h-"� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. ® � --i Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) < -- o 11.n -- - Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's�H_ i hway: D:Yes cU No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other = '= Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 6 era Number of Baths: Full: existing new Half: existing new" 1 r� 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 ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board f Appeal Aut rization ❑ A eal # Recorded ❑o g oa d o ppe pp Commercial ❑Yes o If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ez�� Telephone Number Address / �� f� i� License #�Z, Home Improvement Contractor# Worker's Compensation 9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE i a FOR OFFICIAL USE ONLY tAPPLICATION# DATE ISSUED c MAP/PARCEL NO. i c ADDRESS VILLAGE OWNER 'r its f DATE OF INSPECTION: FOUNDATION FRAME c INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT. ASSOCIATION PLAN NO. i r Massachusetts -Department of Public Safety r` Board of Building Regulations and Standards Construction Supervisor License:"CS-100988 „ HENRY E CASS110 r w 8 SHED ROW WEST YARMOUTH Expiration Commissioner 11/11/2015 4 _ lilt � ; _ � �:�'��'l<' '' t,( 'C?�;�1�`1.;C711•�l:'E Ct'1��� G`.-�� �L.C7.J�1E�'f��?.lf�lt'��J a � ' Office O1"C0ri�;urzlti �tt4l:it rind �3us i ess Rc�t.11L1tC0[1 10 Park Plaza - Spite .51,70 Boston) Massach6setts 02116 I a c�r11�. ltlzprc�vnlent.�'otitractor,leisti aliori P,e istration, 153567 lvpe: Private C:urijoia wit Expiration: 12/15/2t1 4 'I 1 'IM I i;OD INSUt_AI-ION, iNC I 1 NRY CASSIDY __ .. F�F:AI-\DON .CIRCL.E YARMOUT.f-i MA "02�64 U p(late AiIdI css and t etui'n utt tl.N111ii I rctlsu(1 li)l dianl;e. " Address Ret)ctval I?nII)I,uyt)(unt .{ i t usfl'ard ... �"lj't :/rI/Gt,/r r(•t rrl C/i c` l�:''l(ir llCrclFl ulr<FJ ". - ,'. � . I.wtjuut4( Ai fit it's , ltusiocss Regulatiull Liccllse or regutratiou i,Ilid for ilidif'itlul use otily t 2.1, lgtumr" IMNKt)VkM NT' CUN`t KA( Tl�ti bel IV,the expiratiun(lat( if tuuu�l.i 4luru lU, (� oytatruUun; 1'Ype: Attti s an(t Business t�ibutuiiou� u u .4 Ifirltun: 'I:'!I-.`�l2U14- Private Corporatiol 10;1'i F l'I Iia Sutte,5170 - - tiustuu,<'IA 02116 I101%1. INCf .. to fl(l LI'5411'1'C1711'�' F Of t••iIl tI'ItIJo { ,lim I'l" The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mrass.gov/dia Workers' Compensation Insurance Affidavit: Butildens/ContractorsAElectricians/l'lurnbers Apl,lit::,at Information 1Pl�ase p`rirtt I e�ibly NalY1C }3usinesslQrbaniratiot>/lndividual 4 `is,ov Phone #: J� 1_717__-�J 2 4/- :ire your nut employ r? Check the appropriate box: 1. 1 arit a employer with. 1 1 4, ❑ I am a general contractor and I Type of project(required): ctuuployees (full an44�or`part-time).,o have hired the sub-contractors 6. ❑ blew construction _'.❑ 1 an) a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9• ❑ Building addition required.] -5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions .❑ 1 am a homeowner do' all work officers have exercised their g ;d 1.❑Plumbing repairs or additions myself. [No workers' comp, night of exemption per MGL 12.❑ Roof repairs insurance required,] t c. 152, §1(4),and we have no 3a.❑ I am a homeowner acting as a employees. [No workers' 13.MOther z general contractor(refer to #4) comp.insurance required-] AnY aPpdcant that checks box#,I must also fill out the section below showing their workers'compensa[iod j licy infor naaion. Ftumcuwucn who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Cuuuuton that check this box must attached an additional sheet showing the name of the sub-couawwrs and stave whether or not those entities have cutployccs. If the sub-contractors have cmployccs, they trust 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 tnfurmatiurt. Inyuroncc Company Name: ��/�ji/J/C ,--<y,?v Policy#or Sclf=ins. Lic. j >/ Expiration Date: �i/ �� /i� Jot)SttC Address: 4", V Id City/State/Zip j/ Atuc:h u copy of the workers' compensation policy declaration page(showing the policy number and expiration date). -'allure to 36curcacoVerage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine 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 tine of up to S250.00 a day against the violator. BC 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/ rider the nd penaldes of perjury that the informtadorr provided ove i9 tare and correct PP '0,(j`ic.ial use only. Do not write in this area, to be completed by city or town official City or`I'owu: Permit/License# L tn"htrthority (circle one): t oard of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector thertuct Person: Phone#;' CAPECOD-27 ...._ MYOUNG E(MM1 �-- _ CERTIFICATE OF LIABILITY INSURANCE DATE ol I HIS CERTIFICATE^IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NOR—RIG ------.UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,thepplicy(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 tho cui(iticate holder in lieu of such endorsements . PRunucER License# PC-514062 colvrAcr --- Rogers rX Gray Insurance Agency, Inc. NAME: Margaret Young 434 Rtu 134 PHONE IFAX At o Ext: South Dennis,NIA 02660 EMAIL -----`--- ADDRESS:nlyoung@rogersgray.corn INSURERS AFFORDING COVERAGE NAIC If I -.----.-....._............._._.._.-------.._:._._..._._.--- INSURER A:PEERLESS INSURANCE COMPANY INSURER 13:COMMERCE INSURANCE COMPANY Cape GodJnsulation, Inc. wsuRERc:Evanston Insurance Company i '18 Reardon Circle + wsuREliIi:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 -- --•--- ----_—.__._...._.._ ._.___ INSURER E: INSURER F•. - COVERAGES CERTIFICATE NUMBER:_ REVISION NUMBER:A THIS IS 10 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 1.0 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY.REQUIREMENT, TERM OR CONDITION,OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECI'TO WtIICHTIIIS t.ERIIFICAI E MAY BE ISrS',UED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ATSDC SUBR' LfR fYPEOFINSURANCE T POLICY NUMBER MMOOYYYFY MMDDYEYY — LIMITS - GENEitALLIAMI-11Y — - ---- ---...-._—�--- EACH OCCURRENCE - $ 1,000,000 A X c:U_MMERCAL GENERAL LIABILITY T CBP8263063 411/2013 411/20'14 -UUAMAGETO RENTED^ '-- - 100 000 PREMISES Ea o�ulrronco) $ _ CLAIMS-MADE I_X J OCCUR MED EXP(Any one pecwn) $ 5,000 PERSONAL N,PDV INJURY $ 1,000,000 GENERAL AGGREGATE 3 - 2,000,000 GEN t Al k-h-GA-I E L.IMIT APPLIES PRODUCTS-GOMPlOP AOG $� 2,000,ODO PRO--A...1.. d—�..,IL' ..��__t_EOG..—._..___.. - $ — AUTOMOBILE LIABILITY CFMDINtD R LE LIMI I Ea acodan 1000l) $—_ ,000 B AN)Aulu 13MMBCKVMK 4/1/2013 4/1/20'14 BODILY INJURY(Per petson) $ALL ' - I I AUlOSNLD X AUTOS BODILY BODILYINJURY(Par acrAdent) $ ! X rnHEDAU'I'OS X NON-OWNED PRdPERT1-U9- GE --7-'- ._. .T. AUTOS ?; PER ACCIDENT' _ $---., .--- X .UMBRELLA(_IAS pi OCCUR - EACH OCCURRENCE $ 1,000,000 • C txC"sLIAO _ CLAIMS-MADE XONJ453512 4/1/2013 4/1/2014 AGGREGATE $ 1,000,000 LIED X II RE I ENTION$- 10,000 $' — WORKER$COMPENSATION WC STATTU O- — AND EMPLOYERS'LIABILITY i U ANY PRoI'RIETOR/PAR INERIEXECu-RVE YIN WCA00526904 6/30/2013 6/30/2014 E.L.' EACHAcclDervr - 1;000,000 01'F'IC ER/MEMBER EXCLUDED? l� NIA —__.—_ —.__. .... (Mandalory In NH) E.L.DISEASE-EA EMPLO I If ws.dnsaioa under --.-..-YEE $_ 1,000,000-. OcSCRIPI'ION OF OPERAI'IQIVS below E.L DISEASE-f'OLIL Y_LIMIT $ �1,000,000 I I , UcSCRIP I'ION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) - Workers Compensation includes Officers or Proprietors. Addtional Insured status is provided under the General Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201 U/05) The ACORD name and logo are registered marks of ACORD i OWNER AUTHORIZATION FORM I, Q (Owner's Name) owner of the property located at (Property Address) - , (Property Address) hereby authorize 414 h ' (Subc ntractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. 1 , 2a- Owr4rs Signature Date. i DEC 2 -' f e I • � ��/i�l�y CAPECOD INSULATION FIY OY YfA9f ftAMlfS3 fPRNT FOY.M.9YSPENO[Y - YRR9 JURfYL INfuu9lpry C(1(INY9- - - 1-800-696-6611 J'own of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: De&r Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performeel 8t. completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did'this in accordance to the specifications listed on the.building,perinit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. ProRparty Owner Property Address Village Tom-es "keV/ a CN,40-r 57 Ce,-44i/1<�. 1115uLMOn Installed' Fiberglass Cellulose ' R-Value Restricted Unrestricted Ceilings Slopes l�loors O Walls sincerely He ry L Cas: y Jr, President (.' e Cod I ulation, Inc.. f sr _ Town of Barnstable *Permit# LV P�oF r �o Expires 6 months from issue date .'s , Regulatory Services Fee 9� MASS. $ Thomas F.Geiler,Director ��3 e'�1 s639. 2 1 2007 (� pjfD MP Building Division TOWN OF BARNSTABLE Tom Perry, Building,Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number _ Q i S tt'e �x� erc�4����c�110 6 a 03 c, Prope Address _ esidential ., Value of Work a ' Owner's Name&AddressAAA�� �Gf7 I �C� � I � lt9 '3 Contractor's Name �(3YVke - Telephone Number Home Improvement Contractor License#(if applicable) 103 5 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner y shave Worker's Compensation Insurance Insurance Company Name " Workman's Comp.Policy# o V `'�� v ©(o Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑;Re-side -roof(not stripping. Going over existing layers of roof) ❑ Replacement Windows. U-Value (maximum.44) *where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: ope vne ust sign Property Owner Letter of Permission. e vement Contractors License is required. Signature 1 �( Q:Forms:expmtrg The Commonwealth of Massachusetts Department.pf Industrial Accidents Office of Investigations > 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit.:Builders/Contro&ors/Electricians/Plumbers Applicant Information :. Please Prinj jd$t bly Name (Business/Orpnization/Individual): Address: ` C lO1 City/State/Zip: `a .,Phone##• .50151, Type of project(required): Are y an employer?.Check;th7e appropriate box: 1. I.am a employer with 4. ❑ I am a general contractor.and I 6 [� New construction * have hired the sub-contractors employees(full and/or part-time). 7. [ Remodeling listed on the attached sheet t 2.❑ I am a sole proprietor or partner- Demolition . ship and have no employees These.sub-contractors have `$• ❑ working forme in any capacity. workers' comp.insurance. 9, [] Building addition [No workers, comp insurance 5..❑ We area corporation.and its 10.❑ Electrical repairs or additions officers have exercised their required.] ri t of exemption per MGL 1�1.❑ Plumbing repairs or additions 3.El am a homeowner doing all work c 2,§1(4),and we have no 12.❑ Roof repairs myself.[No workers comp. insurance required.]t . employees::[No workers' 13 ❑ Other, comp.insurance required.] •Any applicant that checksbox#1 must also fill out the section below showing their workers'compensation policy information: '* t Homeowners who-sabmitthis affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit rnusuch tcont wwrs that check this box must attached an additional sheet showing.the name of the subcontractors and their workers'corr►p.policy I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. (� Insurance Company Name: Policy#or Self-ins.Lie.#: 1 o t?g C1 q 3 U r ,?,C)o 7 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby eerd er the d penalties of perjury that the information provided above Is true and correct: Si afore: ;.Dater. Phone O fficialse only. Do not write in this area,to be completed by city.or town.offu tab own: Permit/License# uthority(circle one): of Health 2.Building Department 3.City/Town Clerk 4..Electrical Inspector 5.Plumbing Inspector Person: Phone M m ation and Instructions Information , Massachusetts General Laws chapter 152 requires all employers to provide workers' compensationfor ir actof hire,employees. Pursuant to this statute, an employee is defined as"...every person in the service of anoth Y express or implied,oral or written." or any two An employer is defined as"an individual,partnership, association,corpo1eSo�naof a deceasedgal �employer,orthe�re of the forego ing engaged in a joint enterprise, and including the legal rep to a to ees. However the receiver or trustee of an individual,partnership,association or other legal entity,enp ying mp Y r the occupant Of the owner of a dwelling house having not more than three apartments and who ur do o therein,work on such dwelling house dwelling house of another who employs persons to do maintenance,co . 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-contractors)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 he 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 bom 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 per it/license number which will be used as a reference number. In addition,an applicant n that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and..under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked the city or town may be provided to the. applicant as proof thata valid affidavit is on file for future permits or licenses. Anew 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 lilce to,thank you in advance for your cooperation alid should you have any questions, please do not hesitate to give us a calla The Department's address,telephone and fax number: - r The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Sxreet Boston,MA 02111. Tel.#617-727-4900 ext 406 or 1-,,877-MASSAFE aX#-617-727-7749 Revised 5-26-05 www.mass.gov/dia r 8 HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES I authorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be performed on this job (i.e. permits, applications etc.) if necessary. Owne ignature C ntractor Signatu Date Date __- — Board of B uHdiung Reg uNtio n§and Standards HOME,WROVEM9ENTCONTRACTOR Registration. 103757 rEazpuraion: .7G9/2Q08 Type PdVate Corporation SPRINKLE HOME'IMPROUEIVIENT, INC. Brad Sprinkle 199 Barnstable Rd. ea Hyannis, MA 02601 Deputy Administrator a a1i r, b BOARD'OF IBUILDWG REGULATIONS ; SF License: CONSTRUCTION SUPERVISOR Number: CS 006643 Birthdate 10/08/1955 ' # �WT Esc ices A0/08/2007 Tr, no: 6638.0 yc3.k. � gs . �. .. 8a®n�tr�ction e CS, Restricted: _00 BRA® K SPRINKLE 190 LOTHROPS LANE W BARNSTABLE, MA 02668 Commissioner r o �� r r r ISSUE DATE 05/21/2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Bryden&Sullivan Ins Agency CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Inc DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 88 Falmouth Road Hyannis,MA 02601 COMPANIES AFFORDING COVERAGE INSURED _--_ Sprinkle Home Improvement Inc 199 13arrisrAble Road"1' ) COMPANY A A.I.M.Mutual InsurancevCo.A. LETTER 1-iyannis,.MA 02661 i THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MMIDD/YY) GENERAL LIABILITY GENERAL AGGREGATE PRODUCTS-COMP/OP AGG. COMMERCIAL GENERAL LIABILITY PERSONAL&ADV.INJURY =CLAIMS MADE=OCCUR EACH OCCURRENCE OWNER'S&CONTRACTOR'S PROT. FIRE DAMAGE(Anyone lire) I� MED.EXPENSE(Anyone Person) AUTOMOBILE LIABILITY COMBINED SINGLE S LIMIT BODILY INJURY ALL OWNED AUTOS (Per person)SCHEDULED AUTOSHIRED AUTOS MANYAUTO ;NO'.,n.t. .:D^:!)TOg GARAGE LIABILITY (Per accident) r _-- —_---- PROPERTY DAMAGE X EXCESS LIABILITY EACII OCCURRENCE X UMBRELLA FORM AGGREGATE $ Ol'HER THAN UMBRELLA FORM WORKERS COMPENSATION AND STATUTORY LIMITS OTHER EMPLOYERS LIABILITY X 'FIE PROPRIETOR/ EL EACH ACCIDENT $ 500,000 A PARNER'MEXECUTIVE oFFICIERSARE: 7004943012007 05/13/2007 05/13/2008 EL DISEASE--POLICY LIMIT $ 500,000 XJ INCL EXCL - EL DISEASE--EACI-1 500,000 COMMENTS/DESCRIPTION OF OPERATIONS OR LOCATIONS: -- -- - --^- --�`------- -- - — --- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE BRAD SPRINKLE HEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 WRITTEN NOTICE.TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SI[ALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. 199 BARNSTABLE ROAD HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE • WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE AGENT NO 3020 OFFICE NO 3020 MARK W SYLVIA 771 MAIN ST OSTERVILLE MA 02655-1903 FARM FAMILY CASUALTY INSURANCE COMPANY 508-428-0440 NCCI COMPANY NO. 16721 POLICY NO 2001WS185 -[ INSURED AND MAILING ADDRESS: RENEWAL OF NO. 2001 W6185 JOHN D BOURQUE EFFECTIVE 12/14/06 SEE EXTENSION OF INFORMATION PAGE PO BOX 1005 MARSTONS MLS, MA 02648-5005 THE INSURED IS PARTNERSHIP Workplaces covered by this policy: ST WP NO. ADDRESS OF WORKPLACE RTGAUR NO. INTRASTATE NO. MA 01 80 CROCKER RD 335749 WEST BARNSTABLE MA i,.• `�''" -�i:->: '�';>:�^v:`�••,>u ..�: ti:ya �;;•;2`` %c':)'>:t:>�•:.7•.;,�:f•,'c.•.:-r}.+th'::••'>`• < -r`",-:::+>.�+-::,'4jt`:, ,.::• :. .:• .; :.,:: .: :... 3:• .•;9•:.:1d;3 �'.•.+"•ry?•� 'i'% < .� R .{•r:,:Y" '-^`?ti Cfil.�i.;4.>,4>f3fi4 ,f0'>`. .., "" 0 1:;:. The policy period is from 12/14/06 to12/14/07 12:01 A.M. Standard Time at the insured's mailing addrer >• (•4; fit`#• - ,,- >' •h' .`,<.• ••r_ •kr':.�. c;= ` '•.;i: r th '- ?'••'uc��� �rfi-"+��>.•'f+.r' S>�.••-."~ .',b.;• ,:�:`` -;•:i _ .-- - :c•:'.-;.c�: ��: :::.f,}C:'.`,.;� :!?%. :.:s.•. .:>•.:>>..,•..: :..:ia•£;r -------:.•-x:;::,---- ,.,M1.:.:'.:»...::T:••'t •2w::''•;:;h• ��i�.= r>s} ""'v - „ ,{,' +:::2•� ::. s;3:.x/.;+ :rc 3?:4Y'i�C "trf:':e,`.i>�j':•• •.::Co:,'�5..'•t. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the state listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury By Accident Bodily Injury By Disease Bodily Injury.By Disease $ 100,000 each accident $ 500,000 policy limit $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except the states designated in item 3.A. of the information page and ND, OH, WA, WV, and WY D. This policy includes these endorsements and schedules: WC 00 00 OOA WC 00 00 01 1 WC 00 01 13 WC 00 03 15 WC 00 04 14 WC 20 03 01 WC 20 03 02 WC 20 03 03B 1 WC 20 04 05 WC 20 06 01 COUNTERSIGNED BY: DATE Authorized Representative Copyright 1997 National Council INSURED COPY PROCESSED 10/26/06 on Compensation Insurance i WC 00 00 01 B f Y Town of Barnstable *Permit# r Q 14 CFj tp�,� Expires 6 months from issue date �. Regulatory Services ee s, 9 NAM �� Thomas F. Geller,Director s 'OTEp Mp'l�, BUJUding Division A Tom Perry, Building Commissioner r 20 200 Main Street,- Hyannis,MA 02601 ®WAI 0/__ 04 office: 508-862-4038 '4�/�7q Fax: 508 790-6230 �F EpRES5 PERMIT APPLXC -press IRE�SIDENTIAL ONLY Not YaUd without Red p Map/parcel Number .2`fg� of S (i�t,o2p /Js 5)= Property Address � Value of Work 2 J6 KResidential 1 o Owner's Name&Address (,_ 't 5 Telephone Number Contractor's Home improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) /" orlomn's Compensation Insurance Check one: [] 1 am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Worlonan's Comp.Policy# Permit Request(check box) e-roof(stripping old shingles) All construction debris will be taken to �0_ (�Re-roof(not stripping. Going over existing layers of roof) [] 'Re-side. [] Replacement Windows. U-Value (maximum.44) *Where required: Tssmce 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. Home Improvement Contractors License is required. Signature� • �- _. ,r �FtNE t Town of Barnstable Regulatory Services # a�xrr tc•$ Thomas F.Geiler,Director 9�pT16 i9i' Building Division - Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508 790-6230 Property P p er Owner Must Complete and Sign This Section If Using A Builder .;as.Own.er..of the.subject ptopettp- •- . _ uthorizeo .1�. . w i :act on any.:behalf,. hereby a ----C-- :.. V _ all tnattets relative to work authorized bp.this building.pe=ft-applicationtfor. ; 120 CC s (Addtess of fob) , :iegntit of Ownex Date PaintName i DOUG WILLIAMSS TOMB IL I1 CQ. P.O. Box 1069, Centerville, Massachusetts 02632-1069 Centerville. Mass 508-775-1500/1-866-524-0070 capecodhomcbuildcr.c0111 c-mail homcbuilda!u;comcast.no t G 1 ,/die "(Danvnzarzzuea a a xu•ruueCGs _ Board of Building Regulations and Standards I - HOME IMPROVEMENT CONTRACTOR - Registration: 102227 Expiration: 7/1/2004 Type: DBA i COUGLAS L.WILLIAMS CUSTOM 1 I11 fllA' Douglas Williams i BOX 1069 CENTERVILLE, MA 02632 Administrator t j- 1 i i f / zc�uaetla _gin%„Uyzay�u r BOA 'Or UILDI 71 NS SONS RUC ON ERVIS icen e: � umber: CS 0�69 Birthdate: 031 1194/7 19306 ;�..: Expires: 107120 4 Tr.n Restrict : 0 OUGIAS L WILLI S R _ O BOX 1069 0 d inistrator CENTERVILLE, i I `QF THE 1pk� The Town of Barnstable NP �� BARNIASS.LE. Department of Health Safety and Environmental Services 7 MASS. 0a �A 639• �0 lFDMA'�� Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection B F 1 ki Location 20 C,�� C_P—W Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: E Srch t�C--YV\ � C--� oG A S ec e is - ' V of Please call: 508-862-4038 for re-inspection. Inspected by Date /�C� / — J Z i i T"E'O�ti The Town of Barnstable N� OT 9ANNSTABLf.ASS Department of Health Safety and Environmental Services Y N . e p�EUMP'�p, Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection tM Location ZU �}.l l7S ��, Permit Number t Owner Builder �, l L� 1 �}�—• One notice to remain on job site, one notice on file in Building Department. The following items need correcting: Z Please call: 508-862-4038 for re-inspection. Inspected by Date - L S `� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Mom- . �� Parcel ©f l Permit# Heath Division k" �Cf —�� �f�17/O1a— , 5 Date Issu Conservation Division _ %�1Zti0Z Fee Tax Collector gR?0 r d IBC /y L- �� /n a p ` 604 j 0 4 l �- , S ' la / Treasurer �. D'�iSlOfd STEM MUST EE� � f ��® 02 INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5 ENVIRONMENTAL CODE AVO Date Definitive Plan Approved by Planning Board 'SOWN RECUt.lm o r^`; Historic-OKH Preservation/Hyannis Project Street Address 1? C 4/ram 7s Village C�4TVZuI Ile ._ Owner `:imes avcvt f Address Som e, TelephoneA _i Permit Request 1`?X �-c�2-k4 s�ttion -$- `fie A-,T��� i!!�01s7W4 156K N64) l.uco#ZV✓''_ Square feet: 1st floor: existing /3 5.� proposed 0- 2nd f�^^r +' ''" f� Total new �/O� Valuation fj 1�v Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: C'Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Pj Two Family ❑ Multi-Family(#units) Age of Existing Structure 20-t- Historic House: ❑Yes �N'No On Old King's Highway: ❑Yes ❑ No Basement Type: Zull ❑Crawl ❑Walkout ❑Other ff►5���`l Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) fh L Number of Baths: Full: existing new C7 Half: existing new Number of Bedrooms: existing_3 new c Total Room Count(not including baths): existing new_ First Floor Room Count Heat Type and Fuel: ❑Gas Oil ❑ Electric ❑Other Central Air: ❑Yes Zr'N'o Fireplaces: Existing j New Existing wood/coal stove: Cl Yes ❑ No Detached garage: ❑existing ❑new size Pool:❑existing ❑new size Barn: ❑existing ❑new size Attached garage:) existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# __..__ — ---- -- ._.._ - Current Use �n('P. Proposed Use BUILDER INFORMATION Name7_<,160!j En L.C,-)i L_r_c 4-nl S Telephone Number 715—156'b Address�i aa�C Cr)�r� License# L,S 6C6 06?K1�i!'Qt 1495 01-6_3?_ Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE ''�� c'�— DATE `� 6�--` FOR OFFICIAL USE ONLY II' ti E t a I' PEO.MIf NO. r i-E ISSUED _ MXP/PARCEL NO. ADDRESS VILLAGE OWNER _ I • 1 • 1 r DATE OF INSPECTION: , � r FOUNDATION i + FRAME r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH- FINAL FINAL BUILDING / , . 000P y` DATE CLOSED OUT ,, ns ASSOCIATION PLAN NO. RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 S - Alterations/Renovations ;$25.00 Building Permit Amendment $25.00 . FEE VALUE WORKSHEET NEW LIVING SPACE Q� square feet x$96/sq.foot= v x.0031= / plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq. >120 sf-500 sf S 35.00 >500 sf-750 sf 50.00 >150 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$961sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (der) , Deck x$30.00= (der) Fireplace/Chimney x$25.00= - (number) Inground Swimming Pool . $60.00 - Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost The Commonwealth of Massachusetts Z = - Department of Industrial Accidents #MCC OUNFOSM/9811ODS t 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: location: cityN`T hone# ❑ I am a homeowner performing all.work myself. I am a sole Propnetor and have no one worldng mi capacity I am an employer provi ' g workers compensation for my employees working on this job. 'cOmA8nY'name':�>":» �2t�t �� ..:.......... :. .... > ........... -:-. ............. . ... ........... .... ........ .. .:.:............ :.:. C1tV''' :>:::> >n7oa 3..... :.:.:........:::............::............................................................... ❑ I am a sole proprietor; general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: LEM- GOiriDBIV'IIBIn ..........::::.................:...:.. !:w:::??:{•?ii:ii?iv?:'-i?::r?:Ji;a tIT.CJ�v::::::v::+� ::•:::.v:::.:::;:•.... . ::11,{ • ::..i:-4;}?:^:v ...........:.; ...... .. ...... ........... ... . . � ........:...: �: :•.<•:. :':Iron .......+.•i.:'.??i?:ii?:�i:-.......:iv??:•ii^:i:•i?:::•?:?:-:�i:{i:4i:-•......r..........n....a.:......:................... :. •�hsnasrrc NIil ............ :.. RIP s>> .:.. . ..... Iron •.•.�•►1: :L'{�:':�'l.::;:2;is-::i.:.':j::%::;j:}i ::}::F!%�:�;�;:%%jv;:%%�:•:�::�?:�{;+�:�i:^:;:i$,%>;:;:;:`}:;:;:!::�r::;:;::;: ............... ::::..:•:.:::::::•::.:::::�i4::i4:??:iC:::i•?:•i.v-iiiir.}•;+•??+?:?i•Y.ii:tiff::-i???}:%?{•:::J:•:x":�'.:'•i:+ti'•ii.�.:}:;:.}:.;•.:i:-?::..}.•.,.�..:•::•: -::v.•................:......:.....:::•.;.•r;:..::..y...•v:v.•:{_:.,.:...::....;..?}:::{{...�?::.::-::.?.:.�i::•v.:vii-•i.�.i_.�_�.�r..%:.�:..:.:v:. .. :v::?::I•:^"±•:+•?:-Xi•?i:::•?i?:v::Y:b::�:•?:v:?::•:?�::.-..gin:.. ••:: -r.r ........ :::::.?'{>.?:jf:i:•;??i:4::iSii•??i:iry:?:i4i:?:lull:-i}:ir::::'is 'i?':::... ?. ..?':i?::•i{::!'vi?:{:::i;jyji'T%:?:•� v:'r:.::�>:v?ii:4iii?i}:J?ii:Jii?i}:i•:i:T�:::??i:i�iTi::^T:-i:i•:-i?>:<:j:::!:i:;:;L_:j>$:t:'i':ii4 �1��:♦ Fann"to secure coverage as required vnder.Sectlon 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$100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is ow.cud co ect Signature ��� Date O print name Phone# official use only do not write in this area to be completed by city or town ofncw city or town• pers nitAlcense# (Budding Department ❑Licensung Board ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other Ormed 9195 PJA) Information and Instructions lassachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their nplovees. As quoted from the "law; an employee is defined as every person in the service of another under any contract [hire, express or implied, oral or written. m employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of ie foregoing engaged:in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or ustee of an individual, partnership, association or other legal entity, employing-employees. However the owner of a welling house having not more than three apartments and who resides therein; or the occupant of the dwelling house of nother who employs persons to do maintenance, construction or repair work on such dwelling house or on the.grounds or uilding appurtenant thereto shall not because of such employment be deemed to be an employer. 4GL chapter 152 section 25 also states that every state or local licensing agency shallwithhold the:issuance or renewal f a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has lot produced acceptable evidence of compliance with the insurance coverage required. Additionally,meoer the ommonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until cceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting uthority. applicants 'lease fill in the workers', compensation affidavit completely,by checking the box that applies..to your situation and upplying.company,names, address and phone numbers along-with a.certificate of insurance`as all affidavits may be ubmitted to the Department of Industrial Accidents for confirmation of insurance coverage: Also be sure to sign and. late the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is )eing requested, not the Department of Industrial Accidents. Should you have any questions regarding the'law'or if you Lre required to obtain a workers' compensation policy,.please call the Department at the number listed below. �ity,or.Towns 'lease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the L idavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please se.sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retmmed to he Department by mail or FAX unless-other'arrangements the Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. )lease do not hesitate to give us a call. the Department's address,telephone and fax number: The Commonwealth .Of Massachusetts Department of Industrial Accidents Office of InvesugauOus 600 Washington Street Boston,Ma. 02111. fax#: (617) 727-7749 phone# (617) 727-4900 eat. 406, 409..or 375. q ' The 'Town of Barnstable Regulatory Services g Y Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date Z AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing,at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with-certain exceptions,along with other requirements. Type of Work: +t Cc� -r�ti. Estimated Cost 0 Address of Work: 02 U 5 Owner's Name: sadu Date of Application:_ I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied Dow'ner 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 applyabape t as a agent of the owner: __3)0, /� C,w,16 15 Date Co tractor Name Registration No. OR q:forms:Affidav :rev-122001 ORI-�� zy MR ma"mmmo !-- � y�4 S7;*.*� ��f� p��.,�s,j�'��r.��" i�xxY�'3•i,Y����i f �x„� �,., c-� 4 A �/aeomr�nmittue�z 'a�./ iiia�r�u6e I BQARD OF BUILDING REGULATIONS License:.,CONSTRL1CT10N SUPERVISOR Number CS 016981 90 rth date:;03/07/1947 pines 03t0712044 _ T%no: 19306 4 Restricted 00 ,/DOUGLAS l WILLIAMS SR''} PO'SUX.1069 CENTERVILLE, MA 02632 Administrator i SM SCE DETECTORS Q.K. . --------- _-... ___--- _.... . Z<< ARNSTAB G LE BUILDIN DEPT. i J kA I I iI , I, r i . rid- v y II . \\ 1p qi i OD r n ji l � � s cD - 1 • 1 ON o 1 � y -� y s �\ ' - IL LP ' 7S L C.D T W a\ Ar } 1 q� Li ._......... .._.... �.� n .. THE The Town of Barnstable BABNSTABLE. Department of Health Safety and Environmental Services 9 .AS'S. 0I 679• �0 pTFDMPy0" Building Division 367 Main Street,Hyannis, MA 02601 --Office: 508-862-4038 Fax: 508-790-6230 k PLAN REVIEW w Owner: -%1 1. Map/Parcel: `26 � �Project Address: The following items were noted on reviewing: ` j' o V, CI Reviewed by: Date: ' ZI y `� q:building:forms:review 'r . .. :� :E,a % x _ t r r ... e .� h - s' r � •.�4a 3 A'^,;t,,T�'"'! �' , r.- ' 1'z m A �`, r z e r , rt` a r �x is p a _ aJ [Y j° <'a -14 " xlvlv i-," .3 r7;�qys''eT 4L. , y + 3r"Y.S'yam y° - C!4 1:r 'tom+'kn J t }' L £'14 �3 # c 4: 7 y 9 .,IQ ilia 1'` z .T i r � of a � r� - fi -r . a F rA vx t:> ,4 `ti''.""' .�+ 1 _ 11 i4}; 3',F`' +: W a A : ,- -i.s �ll ° ,i s�#.�' 3 t-R t11 y �'�st C"fi'* �, I� �..it T sr $C�`':: �..Y ti'°'��.;-�•R` Ri•. rdtti p`r 'M�ek �xYr�' +k-� 1a1:s4traA"' +7tt- '" - @ 4 ,. 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R'33 YC�'�ir,d ?S' - S&' �P k e� +1,, �t,5k '3:� •*+ �y/S-:`Ll } �r •.r `{> ..a. . ;:� a�r-,'k J{ f'' l,.ii '€';_ir °,�" :-.0 �r`4 ''''„,crl d ,si:j'dm: ""k^.. u r {3 r ti `o, R '$:�,.,fiX x •:.. ! #� � ,}':.-r,,y�,,,,.. :, ;t�>,'+e os a.ur4c c^*;4 R,�r r c t3'Y.P•.Lt�,,��,r ' : rat 3 ��'' .. 5.." � op z �t ,�.. °= I d y e"��Mlu p a1+t'.^sw�` .`, ys' 4�.'r" �^1.''�: .-'b'k ;.. .�` , ,"H a,.ar r `' , 3a ";+t --------- --------- ,. -,r .,,--: ..... -__..,a,b Hdr` -s. .5 a. f'�i^ 3! .:,; • ��QyofTNEtp�°� 'y TOWN OF BARNSTABLE i BAMSTADLS, i M6 BUILDING INSPECTOR 0 0 Mpr a 0 APPLICATION FOR PERMIT TO .............. ................................. TYPE OF CONSTRUCTION" �� �� �'�+ R^" '!? .................-00e....... .. .... ........................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to' the following information: Location ../rl1l�� '..�.A& ...�r.. ?i l !,5... .... .vTf .{ 0.���). t F............................................................... ProposedUse ....Aeif 1P�r.1..?i..;l..z....................................................:............................................................................ .................Fire District .... �� ��� Zoning District ........... ..... ....:............................ �.?'�:.......................'.................................... Name of Owner 70—W 1.-0.0.....................Address /.l1c'l.!�, Name of Builder �02 �.. r... f��ll,�6/N.. ..............Address Name of Architect /... 1/ 9�C.. �c.. C.3' . . ..�i�O�nE.��.........Address ...... Number of Rooms ............X/.X.........................................Foundation coo°e". '&-,,.Pv s Exterior ��. ....., '-.. ..�taWW•� ..................Roofing ........ . ..10. ....... Floors ...... .................................Interior 1.104r.e• Heating aC /./1�s1!�.Iia?7�.1111it?�. ..............................Plumbing Fireplace .....................................................A roximatP Cost ,. O®..... Difinitive Plan Approved by Planning Board --------------------------------19-------- Diagram of Lot and Building with Dimensions "HE PROPOSED METHOD OF PROVIDING FOk SANITARY WATER SUPPLY, SEWAGE DI. AND DRAINAGE 15 HEREBY APPROVED SAL ChiL.� SI` . TOWN 0 BARNSTABLE. BOARD OF HEALTH Pt_ LICENAN 'N87-ALLEI M - RMrT, D INSTALL 35'SySTEA,r, OBTAIN SEWAGE 5 — -rh � M G• V /-/oJs� S f ® ,S-7' o ' I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . rG. �. . �p � f - ' Turner, Michael ' � \. ' . - I/4��I ozma ato:�, No � Permit - --° -----'~ --'—''—'—'--'—'-- . � single zaozzl� .......---'��ye��—��J� ~'--''------- . ^~� ' ' '--~_ Cbi3��s 8trmet ` _-__ —.-----...--....'-,.--.---. ! ` -.^ ..^,ille ,..--.--.—.—...---._.—...—.—.--.---' � Owner ---.-��x��aaI,3�zxn»�_..______. Type of Construction ...................frame............. � —^—^^^~^--^~'—'—`'--~—^'~-------`— > ' | ' Plot ............................ Lot ................................ ' , � "arch 30 72 Perm Granted l� . / Dote of |nxpectioR� 11 lR � \ � } --- Completed 19 � PERMIT REFUSED -----_—.--.—.—.-------'. 19 ~ �* ----.----_—.---.—_.---.—.------ ' | .................—....—_..'..--.—_—,—..,_.+.'' V � . � . . .----'_...-.—._.-..-_--_—.~...,..—' . � .. —`—'—'—^^'~~^^^^'----~'~^'~'~~^~'----~'' | / | > / | Approved ................................................. lR ! ` \ ' ' \ '-----'--`~'----'--~----^^'~^^^'—' / ' \ . . � . ' ' | } Town of Barnstable FTME T°y Regulatory Services do " Thomas F.Geiler,Director ' �' MAW. Y Building Division i6Sq• Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT# mod f FEE: $ �� - SHED REGISTRATION 120 square feet or less CCOERV 1 LLB Location of shed(address) Village. ra 11TPc"F-s S, r b itq C R, Roy i L Sob- 77F 6 S57 Property owner's name Telephone number 0 Size of Shed Map/Parcel# Date Si e VIS Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? n �i Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 i I 1 f SECTION A -A 1• = 2oao +/- min. from *NOTE: ALL PIPES ARE TO BE 4' SCHEDULE 40 P.V.C. All OUTLET FMPES FROM THE �'-..'.O'to septic tank PROFILE VIEW OF ADDITION TO LEACHING SYSTEM D14TRWTION Bose�BE Existing Foundation SET LE10n FOR AT LEAST 2 Fr. 1Z' CONCRETE CDYER Septic tank cxmn neaet lx s•Rhin 6 in. or finished grade 3' of 1/8' - 1/2' Washed Peaston 6Yode over Sepik Tank - 99.50 Croft over D-Boa - 99.00 9%w SAS - 99.00 /4' to 1 1/2 washed Gushed Stone 3- 5-�T ROUTE 28 A\ iaocxouTS 5.5• I NKLET S 0'02 3 HOLE H-20 44' NEw s-0.01 DIST. BOX 3' k mum coHr Ir - L Tap of SAS - Orc -9s.oD le P SIT s� to 1,500 GAL. F"Ralf EXIST. F�tNDATII?1 '� $EPT1C TANK �' S• 0.010' per toot • EtfectM �� 10.5' 4' - SCH. 40 T 1•7y n 7 �Q/ „ rn H-10 «...ewa rn u1 S bd h Ix � u N PLAN SECTION GROSS-SECTION '0 sir 1 to1' u °i a In rn M 4 Ur11ts a 6' 24' -PINE STREET h 3 P� SYSTEM PROFILE ; °o"pacted stone � m a 1' � 3' V STONE UNDER CHAMBERS 3' 3 HOLE H-10 DISTRIBUTION SOX Q Not to Scale 4' NOT TO SCALE LOCUS M A P c 4' 4' 30' Vc 10' 7C Effective Length 5 In.of 3/4•-1 1/2' oanpacted elan• Effective Vieth m SOIL ABSORPTION SYSTEM (SAS) BQitarnsl Test Hgl! 1 E3.r-sD25 _ CULTEC MODEL 125 (H-20 LOADING)/ SHOREY PRECASTE GENERAL NOTES (OR EQUIVALENT)Not to Scale 1. Contractor is responsible for Digsafe notification NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS 12' and protection of all underground utilities and pipes. 2. The septic tank a d distri #on box shall be set o level on 6" of 3�4 -1 1p2 stone. o S 87d 52' 10" W 01 3. Backfill should be clean sand or gravel with no stones over 3 II 1 130.00' 1, 4. This system is" in size. subject to inspection during 3_24•DIAM. ACCESS MANHOLES 1 I I Y j P 9 installation I I by Carmen E. Shay - Environmental Services, Inc. I 5. The contractor shall install this system in accordance I PROJECT BENCH (MARK { with Title V of the Massachusetts state code, the approved plan i TOP OF FOUNDATION I and Local Regulations. 7 �;'.• b I ELEV. = 100.00 ((Assumed) ( 6. If, during installation the contractor encounters any _ { i i 4 soil conditions or site conditions that are different from those shown on the soil log or in our design MET ; I ( installation must halt & immediate notification be THE ACCESS COVERS FOR THE SEPTIC TANK, DISTRIBUTION BOX AND LEACHING COMPONENT I i made to Carmen E. Shay - Environmental Services, Inc. Y. 7r..:"` '' SHALL BE RAISED TO WITHIN 8" OF .- I I 7. No vehicle or heavy machinery shall drive over the • ••' '' •• • �?�'` ' FINISHED GRADE. I septic system unless noted as H-20 septic components. STEEL REINFORCED PRECAST CONCRETE INSTALL 'TUF-TITE GAS BAFFLES OR EQUALS 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. PLAN VIEW ON ALL OUTLET TEE ENDS o II EXISTING i o0 gat. Septic Tank 9. All Distribution Unes shall be 4" diameter Schedule 40 NSF PVC pipes. 3-24' REMOVABLE FRS 3 BEDROOM � 10. All solid piping, tees & fittings shall be 4' diameter j -- A - - i i HOUSE PROPOSED INSTAL ct -ou1 W Schedule 40 NSF PVC pipes with water tight joints. 4' ( ( ADDITION TO GRADE tE 11. Municipal Water is Connected to The Residence and Abutting 3 rah•clearance 13, eaFT • { { #20 p P 9 IN�r • mrT I r-K rnLet to outlet e { i -OUTLET I I Properties Within 150 Feet. IN t o•mla L�T.,�-,t � 1 I h PROPOSED y NOTE: !' 4'-0' min. ea Id d I DECK 1.72 THE PROPERTY UNES ARE APPROXIMATE AND I bs I �y ;pe-•Watt+° LJ \ COMPILED FROM THE SURVEY PLAN GENERATED BY { CHARLES N. SAVERY, SURVEYORS. OF HYANNIS, MA .1 I I � , Failed a ENTITLED " RESUBDIVISION PLAN OF LOTS IN BARNSTABLE, MA" 11r-o• 5'-B' I ( I Leach Pit ` I ASPHALT DRIVEWAY I I `� DATED AUG. 8, 1973, PLAN BOOK 279 PAGE 86 CROSS SECTION END-SECTION 1 I ► AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN r`` I iT SHOULD BE USED FOR NO PURPOSE OTHER THAN 1y� I { i THE SEPTIC SYSTEM INSTALLATION. TYPICAL 1500 GALLON SEPTIC TANK o1� NOT TO SCALE _ __.._..._ w _.._ r o.I - --1- -- _----, - ._ ._.__._ -- �,_.. _ __.r__ -._, _ 0, _ _-__(H- 10 LOADING) I NEW 15M 90I-/ I 1 LEGEND i I LOT #2A i Septic Tank I I 19,486 Square Feed PERCOLATION TEST 10471 DENOTES PROPOSED "1 SPOT GRADE ""� Date of Percolation Test: MARCH 13, 2002 i i I / Test Performed By. CARMEN E. SHAY, R.S., C.S.E. i I i X DENOTES EXISTING l Results Witnessed B DAVID STANTON for Barnstable B.O.H. 90.00 104.46 Excavator: Roberts By Services ( ) O 1 I S 87d 52- 10" W , 5' 0 o SPOT GRADE Percolation Rate: Less Than Z MPI CS ornTEST LE1 1 e *+% � �,� PL PROPERTY LINE A o ELEV.= 99.25 ' ----(96PP}-- PROPOSED CONTOUR + Test Hole Test Hole p No. 1 No. 2 97- - - - - -97 EXISTING CONTOUR - -- - - - -- --- - I DEPTH SOILS ELEV. DEPTH SOILS ELEV. 0 �� iV•• 0 99.25 0 98.78 e -- � DEEP TEST HOLE & Loamy sand I Loamy sand •� 5' PERCOLATION TEST LOCATION 10 YR 3/2 I 10 YR 3/2 I -. 0•-10• Ar 99.00 0 -14• A, 97.80 LOT #2B fo 5' Loamy Loamy ---- ------ -99 •- 6 FOOT STOCKADE FENCE Sand Sand 99___ --------- j 10 Y 5/8 10 Y 5/e M. N F PHILIP H. GO ULDING '10'- 34' Be 98.35 14'- ' Be 95.78 8 San Sand 2 ' / TE HOLE I s Coarse coarse E 98.7 a 23 Y 7/4 25 Y 7/4 PLOT ,20 G 89.25 36 2D' 88.78 PLAN Q V) OF OPOSED SEPTIC SYSTEM UPGRADE Perc #1 ! I Depth to Perc: 48" to 66" OF sgc PREPARED FOR Perc Rote= Less 2 MPI a GILBERT R. D A M E S S . S C O V I L Groundwater Not Observed T. m O No Observed ESHWT i ADJUSTED H2O Elev. = None AT 20 CHILDS STREET Qesi n Colculgtions C 20 40 5098 ------ -98 CENTERVILLE, MA I I I I •Y, .. _ 4., Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V) t, PREPARED BY: Garbage Grinder. No - A Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) o ; CARM�'N E. S��1 Septic Tank : - 3 x 330 Gal./Day 660 USE 1,500 GAL. Septic Tank. SCALE. 1"=20' Cl) = SOIL ABSORPTION AREA: Using percolation rate of Q min./inch ' ENVIRONMENTAL SERVICES, INC. Bottom Area: 0.74 gal/sq. ft. x 300 sq. ft. = 222 gallons ' Sldewall Area: 0.74 gal./sq. ft. x 160 sq. ft. = 118.40 gallons EXIS"ING SEPTIC TANK TO BE REMOVED & LEACH PIT TO BE PUMPED o k`4 P.O. BOX 627 s Providing: = 340.40 gallon ' EAST FALMOUTH, MA 02536 DRY & FILLED IN PLACE WITH CLEAN SANDY FILL. t;g;:�'d` Use: ('4) CULTEC MODEL 135 UNITS, HAVING A 1' EFFECTIVE DEPTH, S 87d 52' 10" W 40.00' TEL/FAX : 508-548-0796 TO BE USED MATH 4.0. OF WASHED STONE ON THE SIDES, 3. OF WASHED STONE NOTE' ANY STRIPPED OUT SOIL CONTAINING LEACHATE SCALE: 1 "=20' DRAWN BY: CES DATE: MARCH 16, 2002 ON THE ENDS AND 1' OF WASHED STONE BENEATH THE ENTIRE SAS. FROM THE EXISTING LEACH PIT TO BE DISPOSED �,I1V S T OF AS PER BOARD OF HEALTH SPECIFICATIONS. PROJECT#SD299 FILENAME: SD299PP.DWG SHEET 1 OF 1