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0069 CONNERS ROAD
a J �' „ 9.. : . � ; v, ' � �-{, ..... ,. ,.,.:; i. �� �.,,,. ;p Mt, -,..a n .. 4 b, i n a I( v°F1"Er��� Town of Barnstable -,' ,��� Building Department -200 Main Street 9 P R 9� . MAS& a Hyannis, MA 02601 1n639. Tel. (508) 862-4038 a Certificate Of Occ upancy P Y Permit Number: B-18-3787 CO Issue Date: 1/21/2020 Parcel ID: 251-030 Zoning Classification: RD-1 Location: 69 CONNERS ROAD, CENTERVILLE Proposed Use: Name of Tenant: Sprinklers Provided: Gen Contractor: SCOTT S SHIELDS Permit Type: Residential -Single Family Type of Construction: Design Occupant Load: 0 Comments: THREE BEDROOM Building Official Date: A Certificate of Occupancy is Required Prior to Occupying Space Building Code: 780 CMR 9th Edition r .k. 'ti .. HOME EWER G- Y RATERS , L' BUILDING, PER06RMANCE TtSTING • , Duct, Leakage Report - - -1 -�3 ' [69-Conners-,Rd Test Mode - , ;.,, . nfervi�Ile Depressurization" 03/15/2019 Test Pressure 25.0 Pascals DC Cook Plumbing Testing Equipment ` 2009 IECC Energy Code Minneapolis• r _ pia'+ �a■ __■■" -- - y Total CFMW5 E or Total Duct Leakage Percentage 0.04 ter- 72.00 < , « �.a 7- Total Square Footage ; •'4 `" ' 1850.00 Maximum Allowable Leakage " 74.00 HVAC Duct Test o "flSTft Served Ring CFM@25 Gauge Duct Leakage % Attic `1850 C 72 :2 J Tu 0.04 69 con 5 R� tENrEi2V�tt,E } ,L, r 180 STATE ROAD SUITE 2U SAGAMORE BEACH,MA 02562-(508)833-3100-ENERGYCODEHELP.COM-INFO@ENERGYCODEHELP.COM powered by cfJc4f1v45 www.gocanyas.com ""W 4ecd9659d32eadbb-15526379C5591 ' .. ; i -•'.,�,5.v': it �.�; ` !t � `�� s .. •i AIRFLOWBUILDING R I S Et CLIENT# 280974 ENGINEERING TECHNICIAN IOH CUSTOMER NAME NASTASIA STORIES ABOVE GRADE 1 1.0 Ranch 1.5 Raised Ranch or Ranch with Walkout Basement 2.0 Cape or Colonial 2.5 Walkout Basement on 2 Story 3.0 3 Full Stories Above Grade TOTAL VOLUME 14446 Cu.FT. Finished areas suitable for year-round use, if they are finished in a manner similar to the rest of the dwelling. IS BASEMENT INCLUDED IN VOLUME? NO OCCUPANTS 3 BEDROOMS 3 BLOWER DOOR# 1214 CFM50 BUILDING AIRFLOW STANDARD(BAS) 1559 CFMSo 70%BAS 1091 CFM50 If blower door#is below 70% BAS refer to ASHRAE 62.2-2016 EXISTING AIR CHANGES PER HOUR 0.27 ACH Assume an overoge 62.5 CFM reduction per hour of air secifing: v.10.24.19 Town of Barnstable Building , • SAMMAKE IP'' 'This Card So;That it is Visible-From the Street-Approved Plans,Must be Retained on Job and this Card,Must be Kept-,,," > Posted until Final Inspection Has Been Made. �erri11� i63p v ° Where a Certificate-of Occupancyis Required,such Building shall Not-be Occupied until a Final Inspection has been made.. Pe'mit.No. B-18-3787 Applicant Name: TRI-S DEVELOPMENT CORP. Approvals Daa Issued: 12/20/2018 Current Use: Structure Per Type: 'Building-New Construction-Rebuild After Expiration Date: 06/20/2019 Foundation: Q Teardown Map/Lot: 251-030 Zoning District: RD-1 Sheathing: Location: 69 CONNERS ROAD,.CENTERVILLE Contractor Name '•..SCOTT S SHIELDS Framing: 1� Owner on Record: NASTASIA,KATHLEEN S TR Contractor License: "CS-065898 2 i Yt, Address: 62 DUNASKIN RD Est Project Cost: $235,000.00 Chimney: CENTERVILLE, MA"02632 } s, Permit Fee: $ 1,323.50 (� Insulation: .Description: REBUILD HOUSE ON EXISTING FOUNDATION AFTER COMPLETE FIRE Fee Paid:. $ 1,323.50 LOSS r Final: 7 Date � 12/20/2018 Project Review Req: EMERGENCY fSCAPE REQUIRED'fROM`BASEMENT. ' p _Cal i Plumbing/Gas b Plumbing:Rough Plu bing: Building Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Final Gas All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and strkturesshall be in compliance with the local-zoning by-laws.an�d codes. Electrical This permit shall be displayed in a location clearly visible from access street or road and shall be maintained opeWfor public inspection for the entire duration of the work until the completion of the same. to Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work:` _ "' " ` `�" ' - Final: 1.Foundation or Footing 2.Sheathi6g Inspection ' 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation Health 7.Rinal Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Wd rk shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: f Town of Barnstable P# Department of Regulatory Services aA : Public Health Division Date 679••�0� 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. Soil S'ui abili Assessment Y 'ty fo S e Disposal Performed By: Witnessed By: LOCATION& GENERAL INFORMATION _ Location Address ` Owner's N i �Z n`tl eu am w,af. " IV , CVA9,_ V1 Of— 2�1 �� Address 61) (_C>YW-kQ r 1 �� �� Us tic— Assessor's I ! l I Map/Parcel: Engineer's Name JA.c.iL. L � NEW CONSTRUCTION REPAIR q 3 Telephone# � '- S �' '� Land Use %2 Ae" let Slopes(%) 0 3 Surface Stones Distances from: Open Water Body CL ft Possible Wet Area__� !C= ft Drinking Water Well *_ft ft Drainage Way yl u., ft Property Line SZ/ ctXt ft Other - ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) .3o G - +1 i +-Z u 1 Parent material(geologic) i't`r!! ;,Iw'A Depth to Bedrock n , Depth to Groundwater: Standing Water in Hole: 2 Weeping from Pit Face 0 _ Estimated Seasonal High Groundwater ? ' DETE ATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observe standing in obs.hole: in. Depth to soil mottles: n CL�, in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft, Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Q A Timed,:► Observation I Z Hole# Time at 9" oa Il - Depth ofPerc Time at 6" Start Pre-soak Time @ ->•� c Time(9"-6') � 1 End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/I) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICIPERCFORM.DOC i w � l DEEP OBSERVATION HOLE LOG Hole# ,� Depth from Soil Horizon Soil Texture Soil Color Soil Othe� Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con istency.%Gravel '! DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency °.Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per�io material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Envir nmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature .,e- -. , :�° : t�tq,,, :; Date l Q:\SEPTIC\PERCFORM.DOC Town of Barnstable P# Department of Regulatory Services 1IMMA13M : Public Health Division Date 39.��� 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. Q Soil Suitability Assessment for Se e Disposal Performed By: Witnessed By. LOCATION& GENERAL INFORMATION Location Address ,,q Owner's Nam `dA rtr�etr� Address by lxirlrl 1 �Xk ) V i 2 j I �C3 ii Assessor'sMap/Parcel: Engineer's Name Jx,*:, l..w.wp�E�p� NEW CONSTRUCTION REPAY 4 '3 Telephone# S �' '�J� " Land Use I%:Ae'"at Slopes(%) 0—7j Surface Stones n L' Distances from: Open Water Body ft -Possible Wet Area �&eft Drinking Water Well 41,_ft Drainage Way t1 V,. ft Property Line Ag ft Other r" "`�"' ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) I ' G I V _ ` � ._3:... I - ' `3�' �r � �*^T= `�'�3� i9"P IF44: CL.Ck f�•��li(�.:�~ �l.�.tC. EIlR!,•;e ���.11��Lth+� fifi Hi. � °��°`� �Y l�.Ef�k:S' !y�•�' i+l Cje1F,.�� K�C�4`.pq,� �ilF ����� � Parent material(geologic) ll�.�t(9eX �Ocrf r! SO--.�� Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face r k Estimated Seasonal High Groundwater Method Used: DETE CATION FOR SEASONAL HIGH WATER TABLE Depth Observe standing in obs.hole: in. Depth to soil mottles: h in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level Observation PERCOLATION TEST Date 0 3 A Time�_a_.-� � Hole# Time at 9" a o Depth of Pere Time at 6" Start Pre-soak Time(. 1� �..,1 �1.oa.+,• Time n DEEP OBSERVATION HOLE LOG Hole# �Othe) Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C n i t c ° Gra el rl 7 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. on 'Am-c-y,° Gravel)_ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. ' Consist c %Gravel Flood Insurance Rate-May: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes 1 Within 100 year flood boundary No_ Yds Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? —�:. If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of En, nmentaI Protection and that the above analysis was performed by me consistent with the required training,expertise and eltperience described in 310 CMR 15.017.. Signature c.t_. q.k•�< , t t:-& Date 4 Q:ISEPTIC\PERCFORM.DOC 0 Application Number............ ......... ..�...�................ BAMISTABM o Pe aftFee.l 4..� 1.100 Total Fee Paid....................:.1.. ..�J...:.? ................. TOWN OF BARNSTABLE � 0� Z i� Pert Approval by... .........................On..�-z��4/� BUILDING PERMIT ;,�z04o � ...... APPLICATION mv.............�5: ..............P................�....- Section 1 —Owners Information and Project Location Project Address (o 9 C- Q r+n e.,a,'5 Y oa d village C IF rn Te a vi i.c- c. � � 0 f Owners cv Owners Legal Address G %0 a z City C cn; State zip v 2- Z 59 rn. Owners Cell# Sob - 1o95 - 3Sa co E-mail -yNA5-TRahn Corn" Section 2—Stractaral Use Single/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3—Type of Permit „ New Construction ❑ .Move/Relocate ❑ Accessory St Ilcture ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4—Detail Cost of Proposed Conshvcii Square Footage of Project' 1 5 4 Age of Structure Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms(proposed) 3 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Last updated:1117=17 r Section 5 -Work Description Section 6—Project Specifics ' Wiring ❑ Oil Tank Storage . � Smoke Detectors Plumbing E' Gas ❑ Fire Suppression .Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply Public ❑ Private YWr Sewage sal ❑ municipal On Site Disposal Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility- R €\A C or\ST\-.uc.T b n I an using a crane C Yes No Section 7—Flood Zone Flood Zone Designation 0 tXT o r- r z e . - 1 Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ I Section 8—Zoning Information Zoning District - I Proposed Use B Esibe fNT I'qL Lot Area Sq.Ft Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Regmred Proposed Rear Yard Required Proposed Side Yard Required Proposed i Has this properly had relief from the Zoning Board in the past? ❑ Yes No Last updated:11/72017 1 Section 9-Construction Supervisor Name'T�k Telephone Number 60 8 - 3 3 7 2 9 Z Address -2 �u.A��latc� road City OS,'eAylilo_ State MAR Zip ®Z 655 License Number C-'-) y(:,58q k License Type C-S Expiration Date .71 1 ° 19 Contractors Email k,-\-�o A,)k f,rn v V,6 . C o 1\n Cell# 5y�3 -13 I understand my responsibilities under the rules and regulations for Licensed Construction Supwdsor 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. SignatureAA Date Section 10—Home Improvement Contractor Telephone Number 60 8 13 :7 -=z 9 62 Address ��,'P rc>^ Cad City 0,;e-aw%\\e State iN) Zip o 2 6,5 5 Registration Number V_+O 9,-JC Expiration Date kT� 15 I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Bolding Code. I understand the construction inspection procedu rm specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your HI-C.. Signature Date Section 11 —Home Owners License Exemption Home Owners Name: - Telephone Number Cell or Work Number I understand my responsibilities under the roles and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedu ms,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Print Name j? . CA Telephone Number S a S z 3 E-mail permit to: i�f1FOC�l��An,nv %--�e . e oN1, Last updated:11n2017 Section 12—Department Sign-Offs Health Department © Zoning Board(if required) Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation For comrnercud work,please take yoar plans directly to the f re deparbnent for gpprovaL Section 13—Owner's Authorization as Owner of the subject property hereby Vauthonze is f h "� /�(s t m f o.act on y behalf, in all matters relative to work autho ' by this building permit lication for: f� (Address of j ob) AV Si a of 0 vnerdate t Name Last Wdahm&1IM017 10� Liberty The Ohio Casualty Insurance Company Mutual® 62 Maple Avenue, Keene, New Hampshire 03431 SURETY BOND Bond#601142398 KNOW ALL MEN BY THESE PRESENTS:That we TRI-S Development Corp. 72 Briar Patch Road Osterville MA 02655 Street Address City State ZIP Code (Full Name[top line)and Address[bottom line]of Principal) (hereinafter called the Principal)as Principal,and, The Ohio Casualty Insurance Company with principal offices at Keene,New Hampshire(hereinafter called the Surety)as Surety,are held and firmly bound unto Town of Barnstable 200 Main Street Hyannis MA 02601 Street Address City State ZIP Code (Full Name[top line)and Address[bottom line]of Obligee) (hereinafter called the Obligee), in the penal sum of One Thousand, One Hundred Thirty Six Dollars and 00/100 (Dollars)$ 1,136.00 " for the payment of which well and truly to made, we do hereby bind ourselves, our heirs. executors, administrators, successors and assigns,jointly and severally,firmly by these presents. WHEREAS,the Principal has made or is about to make application to the Obligee for a License to Construct a Single Family Home @ 69 Conner's Road Centerville. Total Frontage 284 feet. for a term beginning on November 15, 2018 and ending on*November 15, 2019 (*strike out if license or permit is for an indefinite term) NOW, THEREFORE, if the Principal shall indemnify the Obligee against any loss directly arising by reason of failure of said Principal to comply with the laws or ordinances under which said license or permit is granted, or any lawful rules or regulations pertaining thereto,then this obligation shall be void;otherwise to remain in full force and effect. PROVIDED,HOWEVER,AND UPON THE FOLLOWING EXPRESS CONDITIONS: 1. This bond shall be and remain in full force during the term of said license or permit unless canceled in accordance with paragraph 2 below;but if said license or permit was issued for a specific term,and is renewed for one or more specific terms,this bond will be extended to cover such additional term(s) upon the execution by the Surety of a Continuation Certificate, provided such certificate is acceptable to the Obligee. In no event , however, shall the liability of the Surety be cumulative from year to year or from period to period,nor exceed the penal sum written in this first paragraph of this bond. 2. The Surety shall have the right to terminate its liability by notifying the Obligee in writing ten (10) days in advance of its intention to do so. SIGNED, SEALED AND DATED November 15, 2018 TRI-S Development Corp. By: The Ohio Casualty Insurance Company By: �� QL` Martha A Kenney,Attorney-In-Fact S-3853 License or Permit Bond (Unnumbered) POWER OF ATTORNEY The Ohio Casualty Insurance Company Bond Number:601142398 Principal:TRI-S Development Corp. Agency Name:DOWLING&O'NEIL INSURANCE AGENCY Obligee:Town of Barnstable Agent Code:200226 Know All Men by These Presents:That The Ohio Casualty Insurance Company,pursuant to the authority granted by Article IV,Section 12 of the Code of Regulations and By-Laws of The Ohio Casualty Insurance Company,do hereby nominate,constitute and appoint: Constance Boulos; Emily Montgomery;Joanne R. Sullivan;Kelly C.Bolton; Mark McCartin; Martha A. Kenney;Nancy Soule; Robert W. Miller, Tina Boulos of Hyannis, Massachusetts its true and lawful agent(s)and attomey(ies)-in-fact,to make, execute,seal and deliver for and on its behalf as surety,and as its act and deed any and all BONDS,UNDERTAKINGS,and RECOGNIZANCES,excluding,however,any bond (s)or undertaking(s)guaranteeing the payment of notes and interest thereon. And the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Company,as fully and amply,to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected officers of said Company at their administrative offices in Keene,New Hampshire,in their own proper persons.The authority granted hereunder supersedes any previous authority heretofore granted the above named attorney(ies)-in-fact. In WITNESS WHEREOF,the undersigned officer of the said The Ohio Casualty Insurance Company has hereunto subscribed his name and affixed the Corporate Seal of said Company this 26th day of September,2016. �SY INS& QJ"191 q�m o m o 191941 o ��'ti1 A*PSI�aD� David M.Carey,Assistant Secretary STATE OF PENNSYLVANIA COUNTY OF MONTGOMERY On this 26th day of September,2016 before the subscriber,a Notary Public of the State of Pennsylvania,in and for the County of Montgomery,duly commissioned and qualified, came David M.Carey,Assistant Secretary of The Ohio Casualty Insurance Company,to me personally known to be the individual and officer described in,and who executed the preceding instrument,and he acknowledged the execution of the same,and being by me duly sworn deposes and says that he is the officer of the Company aforesaid,and that the seal affixed to the preceding instrument is the Corporate Seal of said Company,and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority and dig ection of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal at the City of King of Prussia, State of Pennsylvania, the day and year first above written. 5P PAS �W@ oIN Ti! COMMONWEALTH OF PENNSYLVANIA 9 Notarial Seal /U� OF Teresa Paslella,Notary Public Upper Merton Twp.,Montgomery County A'�� �0c� uVP�PG My commission Expires March 2e,2021 Notary Public in and for County of Montgomery,State of Pennsylvania '�. Member,Pennsylvania Association of Notaries Aqy t� My Commission expires March 28,2021 This power of attorney is granted under and by authority of Article IV,Section 12 of the By-Laws of The Ohio Casualty Insurance Company,extracts from which read: ARTICLE IV-Officers:Section 12.Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject to such limitation as the Chairman or President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bond,recognizances and other surety obligations. Such attorneys-in-fact,subject to the limitations set forth in their respective powers of attomey,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. This certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the following vote of the board of directors of The Ohio Casualty Insurance Company effective on the 15th day of February,2011: VOTED that the facsimile or mechanically reproduced signature of any assistant secretary of the company,wherever appearing upon a certified copy of any power of attorney issued by the company in connection with surety bonds,shall be valid and binding upon the company with the same force and effect as though manually affixed. CERTIFICATE I,the undersigned Assistant Secretary of The Ohio Casualty Insurance Company,do hereby certify that the foregoing power of attorney,the referenced By-Laws of the Company and the above resolution of their Board of Directors are true and correct copies and are in full force and effect on this date. IN WITNESS WHEREOF,I have hereunto set my hand and the seal of the Company this 15 day of November 2018 �jY INS&A C2 aPo'%, Z L) o Z 1919 hA MP`��.dD Renee C.Llewellyn,Assistant Secretary C0$3N t -.s ue c A WC Guide t® Wood C®>ragtpuction in High Wind Areas:110 mph Wind Zone Massachusetts Checidist for C®mp��auce(780C 5301.2.1,Il)1 Q Check 1.1 SCOPE Compliance Wind Speed(3-sec.gust)........... . .....110 mph Wind ...................................................... ..................... ....:.... nd Exposure Category 1.2 APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) stories 5 2 stories Roof Pitch ............................................. (Fig 2) _T 5 12:12 ............................. ........ Mean Roof Height .........................................:.......................(Fig 2)....:...................... L ft <-33' Building Width,W ...................... ..........................................•.......... (Fig 3)................................ �ft 5 80' Building Length, L ..........V) ...............................................(Fig 3)............................ ft 5 80, ✓'Building Aspect Ratio(L/V1/) """""'••"••••••.....g2 .......................... .... ...(Fig 4).................:......:. s 3:1 Nominal Height of Tallest Opening2 """""""""""'................................(Fig 4).......................... < 1.3 FRAMING CONNECTIONS • General compliance with framing connections................ able 2 ....(-r )................................................................ 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete....................................................:.....:. ................:::.............................................. / Concrete Masonry.................. _L ......................... 2.2 ANCHORAGE TO FOUNDATION1•3 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an altemative in concrete onl Bolt Spacing-general ...(Table 4)....................................... Z in. ................................. ..... Bolt Spacing from endfjoint of plate (Fig5 in.5 6"=12" Bolt Embedment-concrete Fr 5 �in.z 7" Bolt Embedment-mason 9 )................:.:............................ masonry..........................................(Fig 5).......................: in.z 15" ✓� Plate Washer.................... .................... ........................................:..(Fig 5)............................. .Z 3"x 3"x'/e" 3.1 FLOORS Floor framing member spans checked ............... (per 780 CMR Chapter 55)...:............:....:.. Maximum Floor Opening Dimension.........................:.........(Fig 6).......:...... .. l'Zft 5 12' Full Height Wall Studs at Floor Openings less than Z from Exterior Wall(Fig 6... :...................:. Maximum Floor Joist Setbacks ...••••••••••• Supporting Loadbearing Walls or Shearwall................(Fig 1)............................. ............ ft 5 d Maximum Cantilevered Floor Joists """""" Supporting Loadbearing Walls or Shearwall.......:...:....(Fig 8)................... -� -d Floor Bracing at Endwalls ••••••••••••••••••••••••••••••••• ft < :.........................:........(Fig 9).........:....:...........:.. Floor Sheathing Type ....................................... :....:..........................(per 780 CMR Chapter 55)........................ c/Floor Sheathing Thickness n. :.......:.....(per 780 CMR Chapter 55 Floor Sheathing Fasteningp )"""""' �n...........:............................. (Table 2)...-'Ed nails at in edge 1n field 4.1 WALLS Wall Height G Loadbearing walls............:.......:..................:......:....:..:.(Fig 10 and Table 5 < Non-Loadbearing walls....:.....:........ )................ ft - 10' c/' ••••••••••••••••••:.:........(Fig 10 and Table 5 Wall Stud Spacing ................................... ) ft 5 20'Wall Story Offsets .....................(Fig 10 and Table 5)...................L in.S24"o.c............ ....(Figs 7&8) ........... ft 5 d 4.2 EXTERIOR WALLS3 Wood Studs Loadbearing walls..alls... (Table 5)........................: 2x�-_Tft j in. Non-Loadbearing walls....::::..•......... ..•.• (Table 5)...............:..............2x�- -ft in. Gable End Wall Bracing I � - •����� '�•'• Full Height Endwall Studs ..........(Fig 10)....................... . -�� WSP Attic Floor Length' """"""""""""" • g ......... ...:...:.......:.....:...(Fig 11).......................... C'�ft 2Wl3 Gypsum CeilingLength if WSP not used "9 ( )..................(Fig 11)........................... z 0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c: (Fig 11 or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking*@'4'4 ft.spacing in end joist or truss bays Double Top Plate Splice Length 11 ........................:......:.........:...............(Fig 13 and Table 6) Z ft Splice Connection(no.of 16d common nails) (Table 6)......................•......'.•.."" " "..••"""• :.......:.... ............... cam. • hr AWC Guide 8® Wood Construction in High Wind Areas 110 mph Wind Zone Massachusetts Chet lilt for compliance(780 CMR 5301.2.1.1)1 Loadbearing Wall Connections Lateral(no.of 16d common nails) ... . ..................(Table 7) .....:..................... ', Z Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)....................:..........(Table 8)...... ................:.......:.........................Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ................................................ (Table 9):.........:.........:...: a 9) 511' ......... _11 Sill Plate Spans (Table 9)....................:. • �ft Full Height Studs no.of studs ...( )................................:..(Table 9). ........................ .. Non-Load Bearing Wall Openings(record largest opening but check all.openings for compliance to Table 9) Header Spans............................• (Table 9)...... :.... ..,....... ft in.<_12' Sill Plate Spans.... Full Height Studs no.of studs (Table 9).......I....::.......:............. ft 6 in.512° ( ).................................... able 9 Exterior Wall Sheathing to Resist Uplift and Shear Simultan ously4) Minimum Building Dimension,W Nominal Height of Tallest Opening2 ................6............... b 5 6'8" ✓' Sheathing Type ......•••• ....................................(note 4)..................... Edge Nail Spacing ..ss)........................�� � •••••••••••••••••••••••••••••• ....(fable 10 or note 4 if less) in. Field Nail Spacing ' (Table 10 Shear Connection(no.of 16d common nails)(Table 10 Percent Full-Height Sheathin ) ..............................................g.......................(Table 10)......... ............. o 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts).............. .Maximum Building Dimension,L Nominal Height of Tallest Opening2................ 6`�s 6'8' Sheathing Type• .............................................(note 4). Edge Nail Spacing ..................... ......................... P 9•••••••••••..................•••.•.•.....(Table 11 or note 4 if less) Field Nail Spacing ••••• in. p g.........................................(Table 11) ..:........:................:.. • /7 in. - Shear Connection(no.of 16d common nails)(fable 11 )••..•... "` ' Percent Full-Height Sheathing ..........................................""""""""""""""""•�.......................(Table 11)....... o 5%Additional Sheathing for Wall with Opening>6'8°(Design Concepts)...:..:..:........... L/Wall Cladding Rated for Wind Speed? ......................................................... 5.1 ROOFS Roof framing member spans checked?................. (For Rafters use AWC Span Tool,see BBRS Website) (Fi Roof Overhang ...... gure 19.. ... )......... _fit 5 smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls JL Proprietary Connectors Uplift.................. (Table 12)..........: .......U=,JU3plf Le ' Lateral.:.......... ........: :.......(Table 12) -..M P Shear. .....................L- If ............................(Table 12) -�plf Ridge Strap Connections,if collar ties not used per page 21... (Table 13) T= Gable Rake Outlooker "' -19�#Plf (Figure 20)....... Q ft 5 smaller of 2'or U2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14) ........U= 7 lb. Lateral(no.of 16d common nails able 14) Roof SheathingType )...R .........L= .... YP •.. (per 780 CMR Chapters 58 at9) Roof Sheathing Thickness "' ..• ••• :... (Table ) in.z 7/16"WSP� Roof Sheathing Fastening....... ........ :.. .....(Table 2).............. Notes: 1. This checklist shall be met in its'entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 6301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 1.10 mph,Guide: a. . Steel Straps per Figure 5 r b. 20 Gage Straps per Figure 1.1 C. Uplift Straps per Figure 14 A All Straps per Figure 17 e. Comer Stud Hold.Downs per Figure 18a and Figure 18b 2, Exception:Opening heights of up to 8 ft.shall be permitted when 5%,is added to the percent full-height sheathing u requirements shown in Tables 10 and 11. 3; The bottom sill plate in exterior walls shall be a.minimum 2 in.nominal thickness pressure treated#2-grade: 6Tl AW CGu ide to mood Construction in High 3�'in dA� resas: 110 mph Wind Zone ' Massachusetts Checklist for Compliance(7so cmR 5301.2.1.1)' _ •-1iWEN THR EDGE REWS ON PAAMING USE8d NUS AT6bim - Ila u - 1 11 11 1 11 11 / [ 11 It f /1. 1 11 1! 17 li 1 d zz 11 11 1 14 11 If 11 1 h0U19LE u ------WAR-SPA - PAiriEt 1 L See Detail on Next Page Vertical and Horizontal Mailing j z for Panel Attachment AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(7so CMR 5301.2.1.1)' w ia L 1 I 1 r 1 1 i 1 FRAMING MEMBERS EDGE 247JWEDIATE i _ 1 1 1 I L r I ___- --^-A� STAGGERED 3"MNV. NAIL PAT7MN . P/WI:L PAWL EDGE DOUBLE NAIL EDGE SPACING DE ML Detail Vertical and Horizontal Nailing for Panel Aitachmen# vi. A WC Guide to Wood Construction in high Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)' 4. a. From Table 10 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: i. Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction, panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists,and girders shall be a double row of 8d staggered at 3 inches on center per the Figure, Vertical and Horizontal Nailing for Panel Attachment f WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 NCCI NO 40959 POLICY NO. WCC-500-5007148-2018A PRIOR NO. LM1CG-5W5007148-2017AJ ITEM 1. The Insured: TRI-S Development Corp DBA: Mailing address: 72 Briar Patch Road FEIN:„"'8313 Osterville,MA 02655 Legal Entity Type: Corporation Other workplaces not shown above: 2 .;.The.policy period is from 05/01/2018 to 05/01/2019 12:01 a.m.standard time at the insured's mailing address. 3.. A:.' Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the °states listed here: MA B. Employers'Liability Insurance:Part Two of the policy applies to work in each state listed in item 3A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease ,$ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. j Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium. INTEA 404881 INTER .SEE CLASS CODE SCHEDU ° fI® Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ( C0nstri0c:#j'bn'*Sbpervisor CS-065898 4pires:07/10/2019 3 8COTT S SHIELDS a 72 BRIAR PAT-5y RD ' jOSTERVILLE MA,02655L ' y Commissioner C�/ce tpo9�zmaoottcrea� P�O Offiee of COnsumerAffalmAuSinewReoutation HOME IMPROVEMENT CONTRACTOR TYPE:C.ornara6on Registration valid for Individual use only before the' expiration date. If found return to: i 7027{�"_'•:`",.-10103t2019 Office of Consumer Affairs and Business Regulation CORP:: 0 Partc Plaza-Suite 5170 TRI-S DEVELOPMENT • ..:-;- 1, r' Boston,MA 02116 SCOTT SHIELDS =i 72 BRIAR PATCH ROAD' CG? ;! OSTERVILLE,MA 02855::`y Undersecretary Not valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Y1 r (is eve-..-rk 4 CG-d p Address: a `i3 c; �.{ i�A A c..t,. c, A A. City/State/Zip: r)54 v v; 1<r /--f 1 G Z CT-5— Phone#: ,-y 8 1 3 ) - a t C a Are you an employer?Check the appropriate bog: Type of project(required): 1.[�TI am a employer with k 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 �Tew construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.; required.] 5. (] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself, [No workers' comp. right of exemption per MGL 12.[]Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Airy applicant that checks box#I 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:_ Sf c.<i r 17 , —/S JvlSvd At-Ce Policy#or Self-ins.Lic.#: W col + < G G `S G G ? X1 F 2 01(E. Expiration Date: S rr Job Site Address: 61CI (_Ic (,n V .mod 3 � *,4'.( City/State/Zip: ft*M CrN Jc jr Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 69 C-3 ;2 Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimuial penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceZee, rtify under t/he pains and penalties of perjury that the information provided above is true and correct sign ature� .�t` Date: Phone#: c 7 3 ? - d Y 6 d- 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.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. pursuant to this statute,an amployee 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. United 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"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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Roston,MA 02111 TeL 4 617-727-4900 ext 406 or 1-977-MASSAFF, Fax##617-727-7749 Revised 4-24-07 w_m= gov/din Town of Barnstable _ • 11 it Post This Card So That it is Visible From the,Street,-Approved Plans Must be Retained on Job and this Card Must be Kept 1GV ` g HA9'IAF7t.�,. i ,, -,, 1 ' Posted Until`Final Inspection Has Been Made. ^ ' " Where a Certificate of Occupancy Required,su639. ch Building shall Not be Occupied until a Final Inspection has been`made� X j Permit No. B-19-574 Applicant Name: DARREN C COOK Approvals Date Issued: 03/21/2019 Current Use: Structure Permit Type: Building=Sheet Metal-Residential Expiration Date: 09/21/2019 Foundation: Location: 69 CONNERS ROAD,CENTERVILIE Map/Lot251-030_ Zoning District: RD-1 Sheathing: Owner on Record: CONNERS REALTY CORP Contractor Name:" FDARREN C COOK Framing: 1 Address: 62 DUNASKIN RD Contractor License: 526.2 " 2 BARNSTABLE, MA 02632 Est Project Cost: $0.00 Chimney: Description: 96%Furnance Install in Attic Two Zones off Heat and Coolie _, Permit Fee: p g $85.00 Insulation: Project Review Req: Fee Paid.- $85.00 w.. Date. 3/21/2019 Final: 10 C Plumbing/Gas Rough- Plumbing: • + Building Official "4 Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after'issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for.public inspection for the entire duration of the Final Gas: work until the completion of the same. ' Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on•this;permit.. Minimum of Five Call Inspections Required for All Construction Work: F. Service: 1.Foundation or Footing 2.Sheathing Inspection ^�-AxA Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage.Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final- Commonwealth of Massachusetts Sheet Metal Permit Map Parcel Date: !9 Permit# 4 Estimated Job Cost: $ / 'On ©° Permit Fee: $ ' Plans Submitted: YES NO Plans Reviewed: YES NO Business License 2- Applicant License# Business Information: Property Owner/Job Location Information: Name: '19a re l r�A Name: _701-7 y IVg S 1"As11R Street: 2e ltwr ti Pr: Street: _�� C,,7012e7 ers City/Towii: 1x2,Af J r-; /)1 //j City/Town: 691)AY4-z.Ill° Telephone: -g 02' 41�Z®-©OII- Telephone: eD Photo I.D. required/Copy of Photo I.D. attached: YES NO Sf ff Initial J-1/M-1-unrestricted license J-2/.M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family ✓ Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept.Approval Institutional_ Other Square Footage: under 10,000 sq. ft.` over 10,000 sq.ft. - ,Number of Stories: Sheet metal work to be completed: New Work. ✓ Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents ` Air Balancing Provide detailed description of work to be done 9� lye Iri"r1mc e ��'s l(p� ` f �U� l © Zones Off INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes ffl'No ❑ if you have checked)Lu, indicate the type of coverage by checking the appropriate box below: A liability insurance policy'911*0 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent ' By checking this boxg I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and'Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Proi Tess Inspections Date Comments a Final Inspection Date Comments Type of Licenser By OR Master Tide ❑Master-Restricted ��� _ G Cityrrown ❑Journeyper•son Signature of Licensee Permit ❑Journeyperson-Restricted �li 2 License Number: Fee$ ❑ Check at www.mass.UQY4 I Email ?C' �c�ol� OFFS � a Ca Inspector signature of Permit Approval e Csrusx�tom�ea��t��c�ir�ss' �,e�rt�e�t c�'1rtdi�st��lccir��' - f}Cce a ' a 600 Wadda artStmet Baswn,MA 02111 IF •tvrm ma- garldra waximrs, Cmmpensa�mIusar zc a Affidavit Bwl&r-d tractarslElecbudans(Pl "beer.€s , ittnj _# Q3�Iafnrt P1mseFFmtF � OF, qg Are you an employer?checktlte apprapxiate b= ' 'TTpe of project trocloired}_ 4_ ❑I am a general coafmcinr and 1.L[ I am a employ uiffi _ 6- .e� as • entgSagees(fiall andfar par�fime�* #rave lvre�the sa'6-cam��s 2_[� I am a sole Fmpfiiet8s brgarhaer- Iis�ed flntlte attached sheep ?- ❑g�°aP' ship and have rpa etor or parayee's - Wiese sub-conf actars h;me g,Q Demalififlr. •w� :For me in=Y g s �°�a�isave�or3cers' 9. El P,uil�ad.ditiflu coIIlp_ir,ercr x,x-� INu ass camp.isurmce 10:r]Ele#dreal=epaim cr adcEfimm 1. .5-'0 Weare a rmparaftau-51 i s 3_❑ lama home o doutg a13 v keys have exE=ed� 1LEI Flumbingsepalm Or gd&fiaus of emmT6nn gerMGI. 1?0 Rflofregars mP719f:IN°waik='CCMF - c-152,§1(4h aadwe banana kcrrramre=egUima-1 i 13-Q{ether . ea3glogees.[N4 WoAe1S1 - camp requiuA] •gag svpF�fnet cbe�Gaz�l else fiIl oaf tie s �brs @ies caadsec�®eapaycgicrosfi� #ERLVauwmmVdw sabot['ais RYUL- R is &�Y dmilg ag warTr and tbffihue aumde cr�sci�s�tt sn�mit anew d� t mom,sarSz '-��.auuscaz6�,.cbecic�s bcz mast s�a�ffi addi�sl s3�eet sTioc�gtben.-x�aE the sub-ca�sd�s�d sTsfe�helLet�mt-fbase er�shs�e ®3�yees.Ifthe�t,�,+,>�tx,�fiac•e�gtof�s,��`r1a°ti�deiu._Q sc�'I�s'•mffip.paIi[g aumbci- 'I �am era eacpI�ar f7iai;i�prauiriirrg�vffrlsexs'cau�rensr�izrn irasrzraur.$fore},�Pr°}'ees $elria�is Elie pzrlicy arsd jaTi site fra,�ar�raafrorc, �. � . In umceCompaagl ame Poficlt or SeFf-ic Ism 1pial Job Site dress Cif l5#afa+2rtp= A tech a copy cdee warhere campemx6onpo7EYZEclarafiam Page(shaving the palicY=mber.and emph atian aa#e}. Failure fa secam cavemge as requiredunder Section 25A of MC3.c-15 can lead to 1'm imposifiou of mm"A peu ies of a fine up to$1500 00 and/or one-geasi a p D $s 1 as cies7.pe s,m iiie farm of as STOP QP (3RY QBDEKand s of up to$250_00 a crag aaaiflst ffie vifl]dor_ Be adviwa that a copy of this sia ae maybe f xwndedJn the Office of I1mS6ga50ns of tie DIA foc insurance covesage vedH -' T tJa Ia er�liy c r t7ti prams 4nd p nr U&?s,9 f p'srjcr}'iliatflia infatrsaa#im}art vsir aiFiim�is bars and cxrnect Date- Z- Z Phuue .. t3ff"use 071£y .DV Rat wrke'ann ads area,to ha samplew by cep arfiaFn offmi^r city ar.'I'aWu: a , `' Per iceFrsE Au&arifg(crrcle ate): ectrizal ear S.P Igor 1.Beard of$-e�Iili �,�g Dgmtnmt 3.CityFovm Clem �P 6.Other f Contact Person: Phase#- 6. u_ uaA�ti ■i r_ ■:n 1� ►■rn w _1 ann ••r• n u ■• ■ ■la��w w■I•m.■ _n m ur "e■ t :nu •• :. 'ON af:a■1 It as 1. 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Yarmouth Branch For: D.C.Cook P&H 69 Conners Road Centerville, MA 02632 Design Conditions: Centerville Indoor: Outdoor: Summer temperature: 70 Summer temperature: 95 Winter temperature: 72 Winter temperature: -2 Relative humidity: 50 Summer grains of moisture: 97 Daily temperature range: High Building Component Sensible Latent Total Total Gain Gain Heat Gain Heat Loss (BTUH) (BTUH) (BTUH) (BTUH) Whole House 24,336 6,385 30,721 44,343 - _- -- (2.5 tons ) First Floor 24,336 6,386 30,722 44,342 Bedroom 1 3,397 908 4,305 6,928 Walk-In Closet 187 0 187 --- . 579 - -- - - --- - - - .... . . .. Bathroom 1 769 227 996 1,816 Bedroom 2-_ _ 1,263 454 1,717 3,687 Bathroom 2 769 227 996 1,816 Kitchen/Living Room 11,148 2,630 13,778 14,958 Entry Rear- . 1,531 516 2,047 3,960 Entry Side - 1,217 433 1,650 2,736 Bedroom 3 _ - _ _ 3,588 908 4,496 6,612 Bathroom 3 467 83 550 1,250 Whole House 24,336 6,385 30,721 44,343 (2.5tons ) HVAC-Calc Residential 4.0 by HVAC Computer Systems Ltd. 888 736-1101 Load calculations are estimates only,actual loads may vary due to weather and construction differences. Page 1 Residential Heat Loss and Heat Gain Calculation 2/21/2019 In accordance with ACCA Manual J Report Prepared By: Snow and Jones, Inc. Yarmouth Branch For: D.C.Cook P&H 69 Conners Road Centerville, MA 02632 Design Conditions: Centerville Indoor: Outdoor: Summer temperature: 70 Summer temperature: 95 Winter temperature: 72 Winter temperature: -2 Relative humidity: 50 Summer grains of moisture: 97 Daily temperature range: High Building Component Sensible Latent Total Total Gain Gain Heat Gain Heat Loss (BTUH) (BTUH) (BTUH) (BTUH) Whole House 24,336 6,385 30,721 44,343 (2.5tons ) First Floor 24,336 6,386 30,722 44,342 Bedroom 1 3,397 908 4,305 6,928 Walk-in Closet 187 0 187 579 Bathroom 1 769 227 996 1,816 Bedroom 2 1,263 454 1,717 3,687 Bathroom 2 _ _ 769 227 996 1,816 Kitchen/Living Room 11,148 2,630 13,778 14,958 Entry Rear 1,531 516 2,047 3,960 Entry Side - - 1,217 433 1,650 2,736 Bedroom 3 _ _ 3,588 908 4,496 6,612 Bathroom 3 467 83 550 1,250 Whole House 24,336 6,385 30,721 44,343 ( 2.5 tons ) HVAC-Calc Residential 4.0 by HVAC Computer Systems Ltd. 888 736-1101 Load calculations are estimates only,actual loads may vary due to weather and construction differences. Town of Barnstable i { Building Department Services BAaxsrAMY. Brian Florence, CBO. MASS. 16j9. ,�� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax:' 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as C+wnes of the subjectprop_;1 hereby authorized(' Eh C�d to act on half; i!- r ,O in all matters C. relative to work authorized by this building pettnit application for. Co :�. . �9 �►, n e2� �a .a �' (Address of Job) F.T **Pool fences and alarms ate the responsibility of the applicant Pools .s are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner $ignatute of Applicant 1/ KI�TI-ILcL'N S uS7�1S14,' . J� Print Name A-; tNatn 41 Q:F0RI'&s:0WNERPERMLSSI0NP00LS .Rev.08/16/17 Town of Barnstable Building Department Services 04 Brian Florence,CBO o Budding Commissioner 200 Main Street, Hyannis,MA 02601 1xws� 1�, www.town.barnstable.maus Office: 508-862'-1038 ax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: \ JOB LOCATION: member \ sinxt. age "HOMEOWNER": name home phone# 1. work phone# CURRENT MAUING ADDRESS: c4hown• state/ zip code The=ent exemption for"homeowners"was a ded to include owner,occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who do not possess a license,provided that the owner acts as supervisor. D ON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she res es or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory�o snc,/nse and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeown . Such"homeowner"shall submit to the$uuilding Q. vial on a form.___ arce�tabke to the B- ldiag Offic,tbat he/she shall be rea i le for an such work euome3 under the buildingennit. (Section 109.1A) The undersigned`homeowner"assumes responsibili or compliance the State Building Code and other applicable codes, bylaws,'rules and regulations, The undersigned"homeowner"certifies that he a understands the Town ofi�amstable Building Department minimum inspection proceduaes andrequirements and that he/she comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family ellings containing 35,000 cubic feet or larger will be requir d to comply with the State Building Code Section 127.0 Construction ontroL HOMEOWNER'S EXEMPTION The Code state that: "Any homeowner performing work for which a building pe emit is required shall be exempt from the provisions oylhis section(Section 109.L1-Licensing of,construction Supervisors);\vided 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 ,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This\lack of awareness often . results in se 'outs problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed a t the unlicensed personas it would with a licensed Supervisor. The homeowner acting as Supervisor is nitimat y responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities regiilre,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_\wPFILESIFORMS\bulding pemut fomLs\ERPRESS.doc 08/16/17 i WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Liberty Mutual. INSURANCE AR INFORMATION PAGE 175 Berkeley Street Boston,MA 02116 Issued by LM INSURANCE CORPORATION 27243. Policy Number WC5-31S-339830-049 Issuing Office 016C RENEWAL OF: WC5-31S-339830-048 Issue Date 02-14-19 Account Number 1-339830 Sub Account 0000 1. Insured and Mailing Address D C COOK PLUMBING &HEATING INC RISK ID " 000273033 70 KERRY DR MARSTONS MILIS,MA 02648 Status 03 .- CORPORATION Other workplaces not shown above: SEE ITEM 4. PREMIUM-EXTENSION OF INFORMATION PAGE 2. Policy Period: The policy period is from 02-20-2019 to 02-20-2020 12:01 A.M. standard time at the Insured's mailing address. 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies.to the Workers Compensation Law of the states 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 $ 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury.by Disease $ 1,000,000 each emplo O r. C. .Other States Insurance: Part Three of the policy applies to the states, if any, listed hie; SEE END WC 20 03 06B �j 4_ Z: � co .�. D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFOR TION-§ff 4. Premium: The premium for this policy will be determined by our Manuals of Rules,*Classifi tions,,Rats ar = Rating Plans. All information required.below is subject to verification and change by audit. Code Premium Basis Total ~V Rate per$100 Estimated Ann al ik Classifications Number -- Estimated Annual Remuneration of Remuneration Premium See Extension of Information Page Minimum Premium $ 312 (MA) Total Estimated Annual Premium $ 3,155 Premium will be billed ANNUAL. Producer 0004020196. : BEARINGSTAR INSURANCE INC 375 AIRPORT - FALL RIVER MA .02720 _ WC 00 00 01 A © 1987 National Council on.Compensation'Irisurance,Inc. WC 00 00 01 B (CA) Ed. 07/01/2011 All Rights Reserved Page 1 of 1 Insured Copy Page 1 Residential Heat Loss and Heat Gain Calculation 2/21/2019 In accordance with ACCA Manual J Report Prepared By: , Snow and Jones, Inc. Yarmouth Branch For: D.C.Cook P&H 69 Conners Road Centerville, MA 02632 Total CFM: 1,200 Room Cooling CFM Heating.CFM Both First Floor 1,200 1,200 1,206 Bedroom 1 168 . 187 187 Walk-In Closet 9 16 16 Bathroom 1 38 49 49 Bedroom 2 62 100 100. , Bathroom 2 38 49 - '49- Kitchen/Living Room 550 405 550 50 Entry Rear 75 107 107 Entry Side 60 74 T 74 --- r. Bedroom 3 177 179 179 x, --- Bathroom 3 23 34 34 C� 4 CID o a t HVAC-Calc Residential 4.0 by HVAC Computer Systems Ltd. 888 736-11�01 Load calculations are estimates only,actual loads may vary due to weather and construction differences. HOME ENERGY RATERS LLC 8 BUILDING PERFORMANCE TESTING Duct Leakage Report 69 Conners Rd Test Mode Centerville Depressurization 03/15/2019 Test Pressure 25.0 Pascals DC Cook Plumbing Testing Equipment 2009 IECC Energy Code Minneapolis K Total CFM@ 25 or Total Duct Leakage Percentage 72.00 0.04 Total Square Footage 1850.00 Maximum Allowable Leakage 74.00 HVAC Duct Test Attic 1850 C 72 [ 22 0.04 �?con*iac s Raja 180 STATE ROAD SUITE 21.1 SAGAMORE BEACH,MA.02562-(508)833-3100-ENERGYCODEHELP.COM-,INFO@ENERGYCODEHELP.COM powered byg convos www.gocanvas.com 4ecd965902eadbe-1552637985591 t Date: June 27, 2018 To: Building File RE: Exposed foundation &dock on vacant property Address: 69 Conners Rd, Centerville Originator: Bob Digirolamo (617-797-0453) Complaint: Attractive nuisance—vacant property with exposed foundation and dock Enforcement Process Steps 1. Initiate local investigation: RA 2. Document/enter into system Yes [33. Contact 4. Property Owner Kathleen &Thomas Nastasia 82 Dunaskin Rd,Centerville 5. Seek access to subject property 6 Seek administrative warrant(if necessary) NA 7. Notify state authorities of findings NA ® 8. Document conclusion OPEN 9. Referred Building/PD Property—251-030 Site is the subject of demolition after a fire. Property now has only a foundation and dock. Property is 0.37 acre in the RD-1 district. Caller is concerned this is an attractive nuisance to kids. He questioned safety of exposed foundation. Area is not secured with any kind of fencing. Kids will be hanging around dock. Appears to be work on foundation (repair?). There are no building permits on file although owner may be performing preliminary site work in preparation of seeking a building permit. 06/27/2018 Will dispatch Bob to check foundation for work and security measures if required. Notifying PD that kids may be gathering on beach &dock when as the weather improves. y Ylo -41116PIS PAPER BUILDING PERMIT ❑ Obtain a permit application at the Buildi Complete the application per 105.3 CMR a Building Dept. counter. ➢ Obtain all required approvals: ■ Historic (for houses over 75 ye ■ Site plan review (commercial ■ Conservation (exterior work) ■ Health Department M-F 8:00 insulation, roof, siding, windo Planning (new construction) ■ Fire Department Commercial projects - go di Residential approvals concl ■ Demolition permits require util and-electrical. 4 s . Town of Barnstable Building - Post,Thls�Card So.Thatit isVisibleFrom ther5treet .A roved:;Plans;Must be Retained.on J:ob,and this Card Must bea+Ke't TAHARNS .: .e ,'.c r'h'� v - yy £ P ..3�,� .k "'Mc k .' t ,• �"i g� ,, Posted Until Final,Inspection HasBeen Made p .�, yam " Wheg _re a Gertificateof.Occu anc his Re uiretl suchf3u Id�n shall Not,be Occu ied;unt�l a F�naf Ins,ection'has been made 1 ei lijl 1 .: ;; -:A�w::kiF�C«.a=. � ;w;:..p s.. �y,.:..� .,..�Q � •.R'.x.-..�.�.:�.�. g ...�:<��..,�.:.. �:���, p .�,,w,. � ,a.. ,. v. ...•: p.��.kr�. .� .. a„�.�.a��...A.�.,�' Permit No. B-18-2323 Applicant Name: TRI-S DEVELOPMENT CORP. Approvals Date Issued: 07/23/2018 , Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 01/23/2019 Foundation: Location: 69 CONNERS ROAD,CENTERVILLE Map/Lot 251-030 Zoning District: RD-1 Sheathing: Owner on Record: NASTASIA,KATHLEEN S TR Contr`actoc:Name ,TRI-S DEVELOPMENT CORP. Framing: 1 Address: 62 DUNASKIN RD Conteactor`License 170270 2 CENTERVILLE, MA 02632 �� Est Project Cost: $25,000.00 Chimney : Description: Add sill and Beam girts to existing and repaired portioned block Kermit Fee: $ 177.50 foundation and garage section "" Insulation: g ; Fee Paid: $ 177.50 Reviewers Note: Date _ 7/23/2018 Final: This permit is issued for the foundation only.iOne or�more permits will be required for the house. RMCK Plumbing/Gas Rough Plumbing: Project Review Req: Building Official w Final Plumbing: Rough Gas: i Final Gas: Electrical This permit shall be deemed abandoned and invalid unless the work autlionzed by this'permitis commenced withinm a six onths fter issuance. All work authorized by this permit shall conform to the approved application and the proved;,construct�on documentstfor il"which this permit has been granted. Service: All construction,alterations and changes of use of any building and structures shall be'in compliance wrth4he local zoning by-Paws and codes.o Rough: This permit shall be displayed in a location clearly visible from access street orroad"and shallrbO maintained open for public inspection for the entire duration of the work until the completion of the same. Final: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Low Voltage Rough: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Low Voltage Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Health 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy Fire Department Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Ipstallations. Work shall ceed until the Inspector has approved the various stages of construction. s� . ' Town of Barnstable Building SA Post This.Gard So That it is VrsibleF,rom the Street.-.•A rovedaPlans°Must tie Retained on Job andrthis Card Must�be Ke,t s, , AN.gT.tg(;!:- € `.'?Y -i '`, ,4,... '� ,,;.,° p:p z a '.&.,• ``'F� *� r ,�•c t,. P . :a M" PostedntilFinallns ectionHasBeen' ade p �: 3, dR Where aCert�ficateof .a <" ?r d such:B°ultlin 5h`all Not be Occu ied'unt�l a Final#Ins ection hasbeen made Permit „ �Occupancyas Requi e B • °�.:.,.w� ,:aa+.,sa2.:'�..a....:ta v .r:�=:.�.. ;, �..�...;:. �,,.. ',,..:�. ,?�Sa,:<.: p a:_�.ia. F-- ��?.�aiaP.a�Win.�``xT . �.a,;.,a�..3,.��-..::., sS1.s ::..:,,a "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT a f 0= j, ih g � f c r K , , s�aNeraet�. _ NAM Town of Barnstable Regulatory Services Thomas F.Geiler,Director 1puilding Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 Property P o er Owner Must Complete and Sign This Section If Using A Builder I Kathleen S Nastasia Trustee ,as Owner of the subject property hereby authorize Scott S Shields, to act on my behalf, in all matters relative to work authorized by this building permit application for: 69 Conners Road, Centerville, MA (Address of Job) �J' d l ; I hozl Signature of Owner Date le en Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:1UsmWecolliklAppMtalLocal\MicrosoMWindows\Tempomty Intemet Files\Content.Outlook1DDV87AAZ\EXPRESS.doc Revised 072110 The Commonwealth of Massachusetts — Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Indivi dual): [ ;,, v i-)C o e 16 P Address: 2d r3r'(.a.c -t--),tA c 2v City/State/Zip: CJS ° c t,-A r G 2 G Phone#: $ v - 7 3 7- o?1 rb o2 Are you an employer?Check the appropriate box: - Type of project(required): 1/[N am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity, employees and have workers' 9 ❑Building addition [No workers'comp.insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Airy 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 vyhether 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: 6 S S 6 C I Policy#or Self-ins.Lic.#:_ l v G, S'D - S�6 07 y S L n,J;7.- Expiration Date: Job Site Address-__c Cr.a.n r(f S 6,.P-A City/State/Zip: d344� W f vi l (r- b14 o 4G�S— 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 hereby cerM under thepains andpenalties o perjury that the information provided above is true and correct Signafore: Date: Phone#: f''6 Sr 7 9-5 C oL Official use only. Do not write in this area,to be completed by city or town official City or Town: Perinit/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 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced*acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants 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 certificates)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 permMicense 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial AQddeuts Office of Investigations 600 Washington Street Boston,MA 02111 TeL 4 617-7274900 ext 406 or 1-977-MASSAFE Fax##617-727-7749 Revised 4-24-07 w.m=,goer#dia "y -- -`-- -"_._WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 40959 POLICY NO. WCC-500-5007148-2018A PRIOR NO. WCC-500-5007148-2017A ITEM ° 1. The Insured: TRI-S Development Corp DBA: Mailing address: 72 Briar Patch Road FEIN:**-***8313 Osterville, MA 02655 ` Legal Entity Type: Corporation Other workplaces not shown above: ° 2. The policy period is from 05/01/2018 to 05/01/2,019 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states 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 liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated t No. Total Annual Of Annual Remuneration Remuneration Premium INTEA 404881 Y INTER SEE CLASS CODE SCHEDU E 1 ' Commonwealth of Massachusetts f Division of Professional Licensure Board of Building Regulations and Standards i ConstrQ.ctjbn-Sbpervisor CS-065898 Espires:07/10/2019 SCOTT S SH(EL.DS • ; 72 BRIAR PAXH t2D ! '' tLE NtA, OSTERVi OZ65b f w �� � COrnnliSsioner & e Wpm& 4 Office oT Consumer Affairs Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Ccrooration Registration valid for individual use only 8ggl 'R before the eVInErtion date, if found return to: 170274 "'-";-;10/03/2019 1 Consumer Affairs and Business Regulation TRI-SDEVELOPME(da'CFjFiP:, ,-• T•` '- w•. Plaza-Suite 5170 3 Boston,MA 02116 SCOTT SHIELDS 72 BRIAR PATCH OSTERVILLE.MA 02655• Undersecretary Not valid without signature 1HE 1, Application Number............................. .23.............. y sat SrAB MASS. LE, Permit Fee.......F�....... ,5=6.......Other Fee........................ 1639 ,Total Fee Paid................................................................. ...... QQ TOWN OF BARNSTA 4 ermit Approval by... ...........:..On.- '� BUILDING PERMIT i ......�3Map.............................._.........Parcel....... ....................... APPLICATION Section 1 — Owner's Information and Project Location Project Address 69rQ A M e r.V 0 0� Village Cr 4, Owners Name KA.A(�L-,--e q kt,+Skt!i;f( 4 Owners Legal Address i,,,x e,_S 1Q,VN- (2-o *J City State t---t Zip a C 2 Owners Cell# '6 [Lr- - E-mail C6Cw Section 2— Structural Use Single/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet E] Commercial Structure under 35,000 cubic feet Section 3 —Type of Permit New Construction ❑ Move/Relocate E] Accessory Structure E] Change of use El Demo/(entire structure) El Finish Basement El Family/Amnesty El Fire Alarm Rebuild El Deck Apartment El Sprinkler System F] Addition, Retaining wall F] Solar, El Renovation. El pool. D Insulation Other—Specify FSection 4 - Work Description V-- e- a At' C e- ckC- l p v \A-Ck & C o h d r a S-ec 44 T oat ii,Antpei- VVIRP)ffl 7 Application Number.................................................... Section 5—Detail Cost of Proposed Construction Square Footage of Project 2 4 Age of Structure /l./UldI Dig Safe Number Total# Of Bedrooms (proposed # Of Bedrooms Existing ) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist Design I • k � Section 6 —Project Specifics i ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ PlumbingFire Suppression ❑ Gas ❑ ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal `❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No � A C6�S� Section 7—Flood Zone Flood Zone Designation &csA S t 0 r Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District o — ( Proposed Use R-15• 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 Application Number.............................................. Section 9— Construction Supervisor. Name c a-t f S" S 1., 12<- Telephone Number E pS: - 3 2 2 2 4 2 Address'20 3 c, r 9a4c4 C',*2 City oR-PJ t(@ State y>,r_�_Zip 5a 6 J-3- License Number C S- ®G. 54'/!F License Type` c Expiration Date '2 el"-S Contractors Email Cell # s d - 7) 7 a C 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�,,legr',ez- Date 2.41-1 3 J Section 10 —Home Improvement Contractor Name S'���t S' ��. �_tcds Telephone Number Address?d ff<:4 i Ph4e4 ee..zl City Q>54-r., l I e State er a�q, Zip a �C.. S� Registration Number E2 e t? G 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 Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number 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. Signature Date APPLICANT SIGNATURE Signature ,� Date rl) Print Name ��o f ,Q S'i� e r /c�S Telephone Number S o 'W s E-mail permit to: Last undated: 12/28/2017 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 I Section 13 — Owner's Authorization 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 T net nnriatpd- 7 SIR TOWN OF BARNSTABLE BUILDING PERMIT APPLICATIQN Q _rk A j 01M OF B RNSTABLE Map �✓ f Parcel �' Alica tion # Health Division ?i_'r 11�' 1 t Date Issued '1 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Gc'_N e..r S" (� (;z�, •tom,y1 L\c lima 6 a (®3 Z, Village Owner 1)Lrsa,-,\A f ti A c za S ,oac- Address •Q,P,)� Telephbne O S� P 1 S'- 7 9 VS-"' C 0, ,J*�r Jh 11,E t .A- 0 A C,-? 2- Permit Request 2 -D o 4 � 3 R _Y ct op C ►J1G A-�� i cy. �`+.�5 l P �1 e +r �����rw��( � X J (� S�s��— ls���r��� � 'l 5 1'�L �(6i�uz�s- •� `�. I' (� r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District , Flood Plain Groundwater Overlay Project Valuation �,��3 .� Z Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) - Basement Unfinished Area (sq.ft) - Number of Baths: Full: existing new Half: existing new 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 of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name T6�t ,p\— (e k,`1 7' Telephone Number Address 9 au License# / D -77 1 Sl1ZJ��O A- MA MA Q�. Home Improvement Contractor# l" ��y & I 1 Email e,4r,-C Q l;'7 ncz rim4nta Worker's Compensation # LO C - C4 4 J' O j y p� ALL ASTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE } FOR OFFICIAL USE ONLY r APPLICATION# ' DATE ISSUED MAP%PARCEL NO. a k v a i ADDRESS - VILLAGE OWNER- - c DATE OF INSPECTION: et ` FOUNDATION - FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH. FINAL GAS: ROUGH FINAL 4 FINAL BUILDING r j DATE CLOSED OUT t ASSOCIATION PLAN NO. r Town of Barnstable Wgulatory Services y MAS& Richard V.Scab,Director , .Building Division Tom Berry,Building Commissioner 200-Mak Street,Hyannis,M. 02601 ,VM-W,toirv.ba rns table.ma-ns bffce; 508=862-4038 Fax: 508-790-6230 Pkoperty Owner Must ComP1ete--un4:Sicrn This Section If Usin ;A Bader I, w �,as C Nv er ofthc subject propeny herbyauchorize.x �j ' A ��1y ,9�,�, ,� .� t ace on:inybehalf, m all matters relative to work authorized by this building peamit app3ication for (Addr�ss'ci f'�li.) "Pool fences and ala mris are the respoi slilky of the,applicant. Pools are not to be filled or ut&ed hc:fore fence is installed and all final inspections°are performed and accepted. ><� _ Signature of Owner SignkuV ppphcan I� i_ ���� g Print Name Print Nate Date / O�FORA1S�Oiy�.sFFPk�,1�15S1oNPC)()IS L The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114--2017 • www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information 7 Please Print Legibly Name (Btuiness/OrganizatiorAndividual): tz�C�-C? - .� ��S'J�� ty�� Address: b. o Ve , o S City/State/Zip: OA-��--' M A Phone#: C-Z f ) 9 , Y Are you an employer?Cbeck the appropriate box: I va 71 Type of project(required): 1 e employer with—L�_employees(full and/or part-time).' 7. Q New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in S. Remodeling any capacity_[No workers'comp.insurance required.) 3Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. D Demolition 4.a I am a homeowner and will be hiring contractors to conduct all work on my property.ro I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions S.a I am a general contracwr and 1 have hired the sub-contractors listed on the attached sheet. 1 .❑Roof repairs These sub-contractors have employees and have workers'comp.insurances �"erWtWjelf, 0 6.Q We are a corporation aril its officers have exercised their right of exemption per MGL c. 14. 152,§1(4L and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box#l must also fill out the section below showing their workers'compensation policy information. ,Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whetter or not thou entities have employees. If the sub-conmactors 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.Lie.#:_ J—� 0 l O y Expiration Date:. 2 — Job Site Address: Ll 21 16 ^1�^Jcg;S A-1 City/State/Zip: _ C e•✓�-"t y f Ile Attach a copy of the workers' compensation policy declaration page(showing the policy number and expirstiol(date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th p an penalties of perjury that the information provided above is true and correct Si e: 7 Date: 0 1 .Phone#: S S (0 (fl�® Official use only. no not w 'e in this area,to be completed by city or town official City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health—:Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone#: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Bow,Maswksatu 02116 Home Improvement Registration Repisb 1, 180481 Type: Privet®Co PWdM r'.1 ��; ••r:•;2f Expiration: TrA2016 1w 2OV84 RETROFIT INSULATION, INC. ;` ����'�"�� w; JOSEPH REILLY � � ` P.O. BOX 105 .•• .� r'" SEEKONK, MA 02771 � updw Ad&=and remrra awd.mark reason for ebi s& Ad&m ❑Reaawal ❑X a1p1 Mpd ❑Loat Card WA 1 v ZOM45MI -- �iSe�oncaro•ercsd�• rarac•rlwas44 DMIY one of Caar w A>f*s&> n Lieease or r a valid for we [i4>41M T CONTRAOM batonof osso aw dabs. Sfa®d Mara bos ' `100061 Type% •Offec oi�a ABain sad Baetaeoe 2ekalabion Co" Prttra4e Typ. n 10 Park Pkuta-Soft 51" 3096N4 MA 02116 RETROW 644 RODBNAN FALLRIVER 4�lA 02T11 i"r• UadaxaromrP Not VAN widwatsipdtbua •• Maasaehua!!a_ - . Deparbwd of Puim.3a1dy Board of 91001 p Rpufaboas and ataadag& ronsirva"s11l1QT i"?.si'cjsrh' Uoaese:COOL, 1 f1 ` „�R .10�pf!d ,¢ P011oa IN afth®k K4 am, **7-191 aedoafm�' RETRINS-01 RBLACK1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 7/27/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. It 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 License#1780862 CONTACT NAME: HUB International New England PHOIC_NN E><t:(508)676-1971 ac No):(508)678-2750 222 Milliken Boulevard E-MAIL Fall River,MA 02722.9946 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Star Insurance Company 18023 INSURED INSURERS: RetroFit Insulation,Inc. INSURER C: PO BOX 105 INSURER D: Seekonk,MA 02771 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 POLIC'7ES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER MMIDD LICY EF MMMID LIMITS LTR INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR X PREMISES Ea oarmence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ LOC PRODUCTS-COMP/OP AGG $ POLICY❑PRO- OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS OS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED F1 RETENTION E $ WORKERS COMPENSATION STATUTE ERA ANY EMPLOYERS LIABILITY YIN A ANY PROPRIETOR/PARTNER/EXECUTIVE/M NIA 0845201 0810212016 08/0212017 E.L.EACH ACCIDENT $ 1,000,000 ❑ . OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ 1,000,000 (Mandatory In NH) r If yes,describe unde E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN National Grid ACCORDANCE WITH THE POLICY PROVISIONS. 50 Washington Street Westborough,MA 01581 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2094l01) The ACORD name and logo are registered marks of ACORD P7MI►��►pl►9�BlII:r► I TOW *�'¢a' U.S.FOSTAGE>>PITNEY BOWES Buil( 200 � HYaI , +T ZIP 02601 $ 005.59' 02 0001361475 AUG. 03. 2011 ' 7011 0470 0001 4525 5105 _ 7011 0470 0001 4525 5105 I ' ' m R. i p�oa�. m� Xa. m 3a 33 0 O - - 9 'aT m • a 0 _ Thomas and Kathleen Natasia m a6 m m 62 Dunaskin Rd. y n m .a.m m m • MM= - Centerville, MA 0-z Qn — Z CP rn m 3 i i Town of Barnstable Regulatory Services BARNUMBM E Thomas F. Geiler,Director ' �� Tiro ' Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 0260.1 www.town.barnstable.ina.us Office: 508-862-4038 Fax: 508-790-6230 8/3/11 Thomas and Kathleen Natasia 62 Dunaskin Rd. Centerville,MA Re: 69 Conners Road, Centerville, MA Dear Mr. or Mrs.Nastasia, It has come to our attention that you have not responded to the letter sent to your property at 69 Conners Rd., Centerville. Enclosed you will find a copy. Please contact this department immediately and obtain all required permits and inspections to correct this matter. By order. A.J. Pulley Deputy Inspector of Wires CC: Health Department Thomas Perry Martin MacNeelly Q:\WPFILES\A.J.PULLEY\69connerspart282011.doc • 1 . m e �. . . Ln Lil fll A u'! � m Postage $ THE, Town. of B i 0 Certified Fee i r Post=0a Regulatory .:' Return Receipt Fee s Ht�s aueatsrAj3LE, (Endorsement Required) • A Thomas F. Geil i61q ��B O Restricted Delivery Fee rFp►�`� Duilding D (Endorsement Required)co L, Thomas Perry,Buildir o Total Postage&Fees . $ - 200 Main Street, Hya -a www.town.barw o sentro - ---_ -- --------- ---- iti Street Apt.No.; �+ . Office: 508-862-4038 or PO Box No. 2AM� .__-__ City State,, j Ip Tomas and Kathleen Nastasia 62 Dunaskin Rd Centerville, MA 02632 Re: 69 Conners Road, Centerville,MA Dear Mr. or Mrs.Nastasia; On Saturday,May 29, 2011,the Centerville-Osterville-Marston Mills Fire Department (COMM FD) called me over concerns they had after responding to a small kitchen fire at the above referenced address. I have made multiple attempts to reach you at the telephone number provided to me by COMM FD without avail. Pursuant to 527 CMR 12.0, I am sending you this letter. After visiting the tenants at the above address, and the facts given to me by the fire department, I have found that the range oven cord was incorrectly ran through the floor, and no electrical outlet exists behind the range for it to correctly plug into. This must be completed by a licensed electrician, and permitted by the Town of Barnstable in accordance with Massachusetts General Law. Additionally, I found the following: 1 An abandoned electric range cable located iri the ceiling of the basement was left improperly terminated and found to be energized by COMM FD at the time: This is an IIVIMENANT DANGER to persons residing within the dwelling, some of which are children. 2. An over-use of electrical sputters in the basement exists, which is a fire hazard. Electrical extension cords and multi-outlet sputters pose a risk of fire when their respective maximum wattage ratings are exceeded. Pg- 1 of 2 3. An electrical receptacle located at the electric panel, and a light switch located at the top of the basement stairs has no cover plate. Cover plates are intended to create a limited fire barrier between the electrical components and surrounding combustible materials, as well as reduce the risk of electrical shock. 4. There is a dryer receptacle with a supply cable entering a hole with no protection from its sharp edges. This poses a risk of fire. In the interest of public safety,please address these issues without delay. I can be reached at the above address if you have any questions. Sincerely, AJ Pulley, Deputy'Wiring Inspector C: COMM*FD Health Dept. Wiring Inspector Residents of residence Q,\WPFILES\A.J.PULLEY\69conners2011AJElectrical.doc Pg. 2 of 2 1/MAY'/2011/TUE 11 : 44 C-0—MM FIAE DEPT FAX No, 5087902385 P. 001 �M{�.R-.yRn,.r ��"' +� . {p� R Jam! utl l^ra.R �{ .a il C1 CENTERVILLE-OSTEFRVILLE-MARSTOIJS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE & EMERGENCY SERVICES 1875 Falmouth Road, Rte. 28 Emergency Number: Centerville, I\IA 02632-3117 Business: (508)790-2375 John M. Farrington Facsimile: (508) 790-2385 Fire Prevention/Administration Chief of Department Facsimile.' (508) 957-5239 Dispatch Center FAX COMMUNICATION MESSAGE DATE: O Cry TO- PH ATTN- �f -r Lau zoo FROM; WE ARE SENDING PAGES, INCLUDING THIS COVER SHEET. PLEASE CALL (508)790-2375 IF YOU DO NOT RECEIVE THE TOTAL NUMBER OF PAGES. CONFIDENTIALITY NOTICE: This fax transmission may contain confidential information belonging to the sender and such information is legally privileged and is intended only for the use of the individual or entity named above. Any copying, disclosure, distribution or dissemination of this information or the tal<ing of any action based on the contents of this communication is strictly prohlbiled. If you have received this transmission in enor, please notify us immediately by telephone and return the original transmission to us by mail or deliver),of our address above: We shall cover the cosl of return mall. Thant;you! '31/MAY'/2011/TUE 11 : 44 C-0—MM FIRE DEPT FAX No, 5087902385 P, 002 A° MM DD YYYY - - ❑Delete NFIRS -1 101920 1 u 1 05 1 ICJ I - 2011 u 111-0001512 ( 000 ❑Cbange Basic FDID ,* state* Incident Date * station Incident Number * Exposure ❑No Activity shack tEi, box e.'X,%01 ea Uae 0% a0lreaa for this incident is provided on the Census Tract Wildland Pire BLOGatiori* �°�ed l•:a a.cq.a a eglteznaeive Location speeifioation". Uae only,for Wildland Sires. MStreet address 69 I_i 1 corrNErxs Ra ❑Intereaction Number/Milepost Prafix Street or Highway Street Type Suffix ❑In front of I 1 ❑hear of I CENTERVILLE �_J 102632 1-1 ❑Adjacent to Ape_/suite/Room City State Sip Code I • []Directions Cross street or directions as a 1leapla C Incident Type * El Date & Times Midnight is 0000 E2 Shift & Alarms 111 (Building fire I Check boxes if Month Day leer Hr M1ri SOC Local Option dates are the Incident Type , game as Alarm ALARM always re lred 2 �], Date. � 1_81 �� . � � COMB D R.l.d Given or Received* Alarm 1k 05 26 20Z1 11.16.58 Shift or Alezms District Platoon 1 ®Mutual aid received I01922 plvjiq 1 ARRIVAL rewired, unless canceled or did not arrive 2 []Automatic Their PDID Their aid reav_ II ® JLrxival * 0.51 1 28 '1 20111 11� 22:57 E3 - &uta a CONTROLLED Optionl, Except for wildland fires 3 �DQ(=tual aid given - � Special Studies� 4 ❑Automatic aid given I 1 ❑COntrolled 1_� 1 I I I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for Wlldland fires incident Number bast Unit special Special N Nona ® cleared 05 28 2011 112:54:24 1 Study IDN Study Value F Actions Taken * GI Resources * G2 Estimated Dollar Losses & Values OCheck this box and akin this section if an Apparatus or LOSSES: Required for all fires if known. optional ill Personnel foxn ;Is used. for non fires. None IExtingu1.ehln®nt by Eire 1 Apparatus Personnel property $I I , 004 , 000 ElPrrimary Action Taken (1) suppression 0001 0015 $�� 001 , 000 12 ISalvage & overhaul Contents ❑ Additional Action Taken (2) -RMQ - 1 PRE-INCIDENT VALUE: Optional 51 1Ventilate 1 other I 00071 1 6006 Property , 1 000 d 000 ❑ Additional Action Taken (3( ❑ Check box if reaourcQ counts include aid received resources. Contents $I __ 1 , 000 , 000 ❑ Completed Modules H1*Casualties❑None Hs Hazardous Materials Release I Mixed Use Property ❑X Fire-2 Deaths Injuries N ❑None NN Not Mixed ❑X Structure-3 Piro II III I ] Natural Gas: 7.0 Assembly use service L� I I •;'"l+ak• a.eve-ar*aa or Era-ma aotiom 20 Education use ❑Civil Fire Cas.-4 2 ❑Propane gas: Qf lb. max (.,;.h_ma psill) 33 Medical use ❑Fire Serv- Cas.-5 �J � 1 ❑Gasoline: .h;�.s,.l c..,,,� 40 Residential use Civiliaw 3 P.rtw,.ant,ia.r ❑EMS-6 4 ❑Kerosene: fm,az bumiaa easipmee e=yartbl.atazy. 51 Row of stores H2 Detector 53 Enclosed mall ❑Haft--7 Required for Confined Fires_ 5 ❑Diesel fuel/fuel oil: a;.l.fu.l e.nk..poze.ba. 58 Bus. & Residential ❑Rildland Fire-8 6 ❑Household solvents: h.�a/ersaoo opiii, cleanup only 59 Office use ❑Dateotor alerted odaupanta QApparatus-9 7 QMotor oil: &..Shaine or pa:lrblo mntaiaaa 60 Industrial use QPersonnel-10 2FJDetectoz ad not alert them 8 ❑ 63 Military use e:on p.iae .. aar.uag c as y,a7cq. 65 Farm use ❑Arson-11 U❑onxnoron 0 ❑OtAmr: aptll>660.1.. 00 0tl'7,er mixed use lease o ate She asebmo form Property Use* Structures 341❑Clinic,alinie type infirmary 539 ❑Household goods,sales,repaire 342❑Doctor/dentist office 579 []motor vehiale/boat gales/repair 161 ❑,Restaurant or c 131 QChurah, place worship 361❑Prison or jail, not juvenile 571 ❑0as or serviCA Station cafeteria 419® 1-or,2-kamily dwelling 599 ❑Business office 162 ❑Bar/Tavern or nightclub 429 Multi family dwelling 615 ❑El®otric generating plant 213 ❑Tlementary school or kindergarten 439❑Rooming/boarding house 629 ❑Laboratory/science lab 215 ❑High school or junior high 449❑Commercial hotel or motel 700 ❑Manufacturing plant 241 ❑College, adult education 459 Residential,'board and care 819 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 4 64❑Dormitory/barracks 882 ❑Non-residential parking garage 331 Hospital Food and beverage sales ❑' 519❑ 3 891 [:]Warehouse Outside g36❑Vacant lot - _ 981 ❑Construction site 124 []Playground or park 938 ❑Graded/care for plot of land 984 ❑ Industrial plant yard 655Crops or orchard 946 [-]Lake, river, stream 669 Forest (timberland) Lookup end enter a Property use Coda only if [� 951Railroad right Of way you have NOT checked a Proparty use box: 907 []Outdoor storage area 960 ❑Other street 'Property Use 1419 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway D31 ❑Open land or field . 962 ❑Residential street/driveway 11 or 2 family dwelling NFIRS-1 Revisio 4� u `� JMM Eire "^���. 01920 05/7.KILVIL01.qi9 `31%MAID/2011/TUE 11 : 44 C-0—MM .FIDE DEPT FAX No. 5087902385 P, 003 KIP Person/Entity Involved I 1508 - 360 - 8595 Local Option Business name (if applicable) - Area Code Phone Number IFABIO I IF " ISILVA I u ®crack This Pox if Mr..Ma., Mrs. First Name MI Last Name . same address as suffix lncidenC location. 6 9 L.J Then skip the three CONKERS - I RD u duplicate address Prefix Street or Highway - Street Type Sines- N e er YP Suffix I .I I I jCENTERVILLE Post Office Box ABt./Suite/Room City IMA 1102632 State gig code More people involved? Check this box and attach Supplemrital Forms (NFIRS-16) as necessary p2 Owner n h._I Some as person involved? �I Then chock this box and skill The zest of this section. Local Option - Business name (if Applicable) - - Area Code Phone Mumbor ❑ Check this box It Mr.,Ma., Mrs. Firs[ Name MI Last Name _ same e Suffix ddreas a° Incident location. Tear, skip the [bras duplicate address Number Prefix street or Highway street Type Suffix lines. Post Office Box Apt_/su I City _ State gip Code L Remarks Local Option Note - Ann.b 326 not added to response" units. 326 to HQ for add. personnel. With 324 signing . on to the inicdent and than Command releasing units From the scene. Amb. 326 return to Sta. 3. 05/28/2011 11:58:16 dbrogers Responded in 321 (l) with 307 (3) , 303 (3) , 304 (3) Sta. 1,2,3 and HYFD 823, to a reported structure fire at 69 Conners Rd. , Cent. r Upon arrival, 1 st wf, smoke showing from side C. Tenant reports gas stove in kitchen is on fire. walk around of building done, found the gas meter on the D side of the building and secured the gas at the meter. Check of the interior through side C rear door reveals fire showing around the stove, heavy smoke condition in the building. Upon arrival of 307, an 13/4" handine was advanced into side "C through the rear door and the fire was knocked down and crew then checked, for extension. 303 assigned to ventilation and 304 assigned toi assist with 'the interior along with 823. Fire was found to be contained to the stove and no extension found, basement and attic areas checked as well, nothing found. Ventilation was continued. National .Grid requested to secure the gas to the stove and check other equipment. The electrical power had been shut-off at the breaker panel by the tenant .prior to our arrival.. Remaining crews stood by .in service. After the fire was extinguished I spoke to the tenant Mr. Fabio Silva who stated he and his family left the house at approx. 10:30 hrs and went down the street to clean at the local G Authorization 18260 I IELDRIDGE, BYRON L. IICAPT I IShift Comm I L 05 29 1 2011 Officer in charge ID Signature Position or rank Asaipnment Month Day Year oxcif2] I8260 I IELDRIDGE, BYRON L. ICAPT I 11 051 U 2011 Position or.rank Assignment .Month Da Year is officer Member making report ID signature 9 Y in cparga. )MM Fife - - M 09n (K/9A/-)ni i i i—nnM 619 .31/MAID/2011/TUE 11 : 44 C-0—MM FIRE DEPT FAX No. 5087902385 P. 004 - — MM DD YYYY 01920 U J_ 5 1 28 1 2011 11-0001511--j 1 000 Complete rDID * State* ineid¢nt Data StationEx Incident Number * p * NHX'XALgYm oeure Narrative: Note - Am.b 326 not added to response units. 326 to HO for add. personnel. With 324 signing on to the inicdent and than Command releasing units from the scene. Amb. 326 return to Sta. 3. 05/28/2011 11:58:16 dbrogers Responded in 321(1) with 307 (3) , 303(3) , 304 (3) Sta. 1,2, 3 and HYFD 823, to a reported structure fare at 69 Conners Rd. , Cent. Upon arrival, 1 st wf, smoke showing from side C. Tenant reports gas stove in kitchen is on fire. Walk around of building done, found the gas meter on the D side of the building and secured the gas at the meter. Check of the interior through side C rear door reveals fire showing around the stove, heavy smoke condition in the building. Upon arrival of 307, an 13/4" handine was advanced into side C through the rear door and the fire was knocked down and crew then checked for extension. 303 assigned to ventilation and 304 assigned toi assist with the interior along with 823. Fire was .found to be contained to the stove and no extension found, basement and attic areas checked as well, nothing found. Ventilation was. continued. National Grid requested to secure the gas to the stove and check other equipment. The electrical power had been shut-off at the breaker panel by the tenant prior to our arrival. Remaining crews stood by in service. After the fire was extinguished I spoke to the tenant Mr. Fabio Silva who stated he and his family left the house at, approx. 10:30 hrs and went down the street to clean at the local beach, when they returned at approx. 11:15 hrs there was no sign of any problem from the exterior. When his children opened the front door the house was full of smoke. Mr. Silva went into the house and saw that the stove was on fi>;e, he came out and told his neighbors to call 911. Mr. Silva then went into the basement and shut down the main breaker at the panel. Mr. Silva then tried to shut off the gas at the meter, but was unable to do so. Mr. Silva states that the stove was used earlier today, cooktop only. Mr. Silva states the oven has not been used in several days. Mr. Silva states he had some minor problems with the stove about 9 or 10 months ago, he had to remove some insulation under the cooktop and has had no further problems since then. Upon arrival of the National Grid, Technician secured gas to the stove and capped the line. The stove was then moved to the exterior and a check of the stove reveals heavy damage to the oven area, the control knobs have been melted off. No obvious caused could be determined due to the damage sustained in the fire. National=Grid Tech then checked the furnace and hotwater heater, no problem found and gas service was turned back on. While removing the stove, several issues with the electrical system were found with electrical cords and a live 220volt line that was uncapped. Several photos taken and overloaded cords were unplugged. The uncapped 220 line was shut off at the breaker panel and then secur'xed at the nearest junction box. The wiring and gas inspectors were requested to the scene, dispatch was unable to contact anyone. A check of the residence also revealed that there were no working smoke detectors in the building, 307 crew replaced batteries and detectors where needed and all-were. working prior to leaving the scene. It was also discovered that there were no CO detectors either. I spoke with Mr. Silva and advised him of the findings and the corrective action needed. Mr. . Sliva will contact the property owner, Mr. Tom Nastasia, and have him contact the FD. Origin of the fire was in the stove located in the kitchen. Damage: The first floor and basement recieved moderate smoke damage, the stove was destroyed )MM Fire 01920 05/29/2011 11-OOn1512 31/MAID/2011/TUE 11 : 44 C—O—MM FIRE DEPT FAX No,,.5087902385 P, 005 MM DD XXXX 01920 1 U ��, 28 2011 � • 1 11-0001512 1, 000 Complete MID * state.* Incident Date * Station incldent Ntmtber. Nesr4tive Expoeure ,* Narrative: and there is some heat damage' to the refrigerator,and the cabinets on either side of the stove. The area around the stove recieved some ..minor water damage. Loss is approx. $5, 000.00. Units picked up and ret. to qtrs.' z turned the property over to Mr. .Silva and cleared the scene. I spoke to the property owner Mr. Tom Nastasia at approx.. 14545 hrs by phone and advised him of what had occurred and issues found with the property, Mr., Nastasia will work with his ` insurance co. to repair the damage and correctproblems, I spoke with the Assistant wiring Inspector,. AJ-Pulley, at approx. 1450 hrs and' advised him of findings. Mr. Pulley stated he'would'respond'to the -propexty and check it out right away.. 05/29/2011 00:07:52 beldridge FII! Fire 61920 05/26/2011 11-0001512 '31/10/2011ME 11 : 45 C-0—MM FIRE DEPT - FAX No, 5087802385 P. 006 A MM DD YYYY ❑Delete WIR9 -2 f 01-4 1 U1 051 128120111 11 " 111-0001512 1 1 000 changa FDID �, state* Incideat Date * 'Station No Activity - incident Number * txposure tk Fire Property Details C On-Bite Materials[]'None complete_tr there were any aignificane - 11 100gnte of commereial,industrsal, energy or O; Products agricultural products or materials on the Property, whether or not they"Come involved Enter up to three codes. . Check one or more boxes for each code entered. $1 1 0001 I ❑Not Reaidential l Bulk storage or warehousing Estimated Number of residential living units in I 1 1 2 Processing or manufacturing building of origin whether or not all units On-site material (1) 3 Packaged goods for sale became involved 4 Repair or aerviee 1 Bulk storage or warehousing $2 I 0011 []Buildings not involved ICJ � Y. 1 2 Processing or manufacturing Number of buildings involved on-site material (2) '3 Packaged goods-four sale 4 Repair or Service $3 ®None I I - 1` Bulk storage or warehousing Acres burned 1 2 Processing ox Manufacturing (outside £ire$) Elless than one acre on-site material (3) 3 Packaged goods.for sale 4 Repairr or service D Ignition E1 Cause of Ignition E3 " Factors ❑Check box it this ie an exposure report. Contributing To Ignition skip to section G Chock all applicable boxes D1 124 Cooking area, kitchen 1 El Intentional 1 ❑Asleep ®Non® Area of fire origin * - 2 ❑ouintentional - 2 P...i biy impaired by _'3 ®Failure of egvipmcnt or boat source alcohol or druga D2 (Undetermined 4 El Act of nature 3 ❑Unattended parson trvmv --I Heat source 5 E]Cauee' under 1nveati.gration 4 ❑.Possibly� mental disabled * - - " U ❑cause vndataxwLnod after iaveatigation 5 ❑Physically Disabled gMulti.plo porsono involved D3 25 jPpplianCe housing or I E2 Factors Contributing To Ignition Item first i ite0 Check Dox if fire spry � ,' � - -. None __.� g0 * 1 t1 7 Age Kae s factor was confined to object 20 '�ahancal I` of origin Rstii0atad age of ' I 'Mt Factor Contributing To,Ignition (1) U D4 � (Undetermined , person envolved Tyga of material Required only t� rst fi.ret ignited ignited coda la -00 or <70 Factor Contributing To Ignition )2) 2 ❑Female Equipment Involved In Ignition F , Equipment.Power G Fire Suppression Factors ❑None If Equipment was not involved,skip to Section c 121 (Natural gas orl Enter up to three code g, ®None 646 (Range with or without I Equipment Bower scarce Equipment involves Equipment Portability IJ 1Non® I - Fire suppression factor 121 Brand (Kenmore _ .I 1 ,ElPortabl®: U Model 1 2 Stationary sire super Ission,factor cz> 1 Serial �1_ ( Portable equipment normally can be moved by one person, is designed t I be use in multiple, locaCion$, and sire auppxesain factor (3) Year requires no too o ls to install. � Hl Mobile Property Involved H2 Mobile Property Type & Make, Local Use ❑Pre-Fire Plan Available 1�None { sWge O£ the information presented in this report may be based upon reports 1 ❑Not involved in ignition, but hurnod Mobile property type - from other Agonoias 2 [J znvol,nad in ignition, but did not burn Arson report attached 3 ❑involved in ignition and burned 1 ❑PoliCo report attached Mobile property.make ❑Coronet report attached ❑Other reports attached Mobl.ie property modal Ycar IUI .. i License Plate Numbar State visa Number NFIM-2 Revision-01/19/99 :6MM' Fire, .. n7Q9nv ArP)Q/7nl1 „-nnn,.e,o '31/MAY/2011/TUE 11 : 45 C-0—MM FIRE DEPT FAX No, 5087902385 P, 007 it Structure Type * 12 Building Status * 13 Building* 14 Main Floor Size* if Firo wsc In analosad building or a $trUCture portabia/mobile stractura aomplata - Height - tho teat of this form count the ROOF as part File 1 ®Enclosed Building 1❑Odor Construction of tna hlghast story 2 ❑Portable/mobile Structure 2®Occupied 6 operating 3 ❑open structure 3❑Idle, not routinely used 001 U 001 r 632 4 ❑.fix supported structure 4 ❑Undor major renovation nt"i• ors.ai. Total square feet 5 ❑'Tent 5 ❑vacant and secured OR 6 Open platform 6❑vacant and unsmourod , ❑ (e,q. piers) 001 7❑geiog demolished xoe.1. 6..oe.w s.. I �I 7 ❑Connecround structure(Work areas( �� BY L 8 ❑Connective structure O❑Other , (e.g. feneeel ❑ 0 ❑othor typo of Structure U Undotarmined Lengbt in feet Width in foot 4T1 Fire Origin * IJ3 Number of Stories K Material. Contributing Most Damaged By Flam® To Flame Spread _ ❑Below Grade Count the ROOF as part of tho highest.story 001 ® Cbeck It no flame agreed . -Skip TO Story of fire origin OO1 Number of stories w/ minor damage OR same ae material first ignited Section L oR unable to deternine (1 to 20 flame damage) J2 Fire spread* L-� K1 �� Number of stories a/ significant damage 1 ®COnCined to object of origin (25 to 49% flame damage) Item contributing most to (lama spread 2 ❑Confined t0 room Of origin 1 , 1•w*-eF of stories .il heavy damage Tin I 3 ❑Confined to floor of origin �1---11- (50 to 74$ flame damage) _ K2 4 []Confined to buildingType of matarlal cootr3batl y Required only if item of origin g most of flame spread contributing Ruclmor of stories w/ iXtreme damage 5 [:]Beyond building of origin US to X008 flame damage) code is 00 or<70 L1 Presence of Detectors * L3 Detector Power Supply L5 Detector Effectiveness �r '�+r "1ib '4�➢I r ,I��� �` °i ��1fle r rl�. �y,.y N J.;." A r. .lit,. " • r ;�� 35••� � y � 'f� •� •4'w.�"�� }�," ,y� ��M!'��'��"��1r,,.',y`-l�r,�y�, r �„{�--^:� y ,����r' ^'�e,,�'•• �+3{+�)'J��'�, �,. ��-y �',JI r / �T a�l�- y�'�"� �!!-:1�I �5.� �✓lW".i�� � P�NI'��1' .' �� �" '��u `��uw(�''tY(v 'L��v(., � ,rya. � �� "�� •�'li ,�y •11" _YI�ee�`�" y,l `�v� �,� y � .+r ufil�,l(. ✓J y T`' �1 1�( LJT1 �� :/ I Iy�;v/✓tJi �(ill) '� � /(�+Y "I"r+0t ell ��5 �. ff�� N '-�° 6'� u 'y Y3 pC��LYETs~ i 1�j- ,�,v' /j ten- '� � �c'�- iy�y:. J,�� 14e_41 S� �_.,y� •yw_C:ss: y�•� s'Y.-0�r�����`JD ------------ '�`, •, I"r.�,•��iJ-'�r'r i "�.�'T'�'a-aV.`�--����'=`-tee rl--�", �' -•��-ems ,^r ' r � .%I/MAY/2011/TUF 11 : 48 C-0—MM FIRE DEPT FAX No, 5087902385 P. 007/010 Structure Type # 12 Building Status * 13 Building* 14 Main Floor Size*' =Rs-9 IZ Fire wee In enclosed building or a - - Structure :portable/mobile structura complete Height _ tho z"t of this form - count the ROOF as.part Fire 1 ®Enclosed Building 1 ❑Under oonstruction or.th4.highest otory 2 Q Portable/mobile Structure 2 ®Occupied 5 operating 3 ❑Open structure 3❑Idle, not routinely need 00 u , 001 , 632 4 [I,Air supported structure 4 ❑Under,major ranovati:on Total nuwb t.t'oa.:�.. Total square feet.' at.r.bey.er.a. 5 Tent 5 Q vacant and. secured OR � ` 6❑Va e eant and umeourad 6 ❑Open Platform (e.q. piers) 001 ,. 0 . 0 ee.totes.. 7 ❑ 7 Being demolished metl ...b— underground structure(work areas) O❑other °i1ep g��°' SY i 8 Connective structure (e.V. fences) 0 Other type of Structure U Q Undatarmined Lengbt iti Feet Width is feet �1 Fire Origin Number of Stories K Material Contributing Most Damaged By Flame To Flame Spread Count the ROOF ae part o£ tho.highost story ' 001 Below Grade Check If no flame spread . Skip TO Story Of fire origin OOI . OR came as material first ignited Section. L I NuAmr o£ stories w/ minor damage OR unable to determine I� (1;to 2d4 flame damage) ►T2 Fire Spread NuaJJeX of etosiee w/ eignifionnt damage I ®Confined to object of origin (25 to-49$ flame damage) Item contributing most to flame spzaad 2 ❑Confined to room of origin. Ntwbes of stories -il heavy damage - 3 �Con£inad to floor o£ origin, (50•to 11 flame damage) - •�,:f ` I ` Type or material cootrlbuting Required only if item 4 []confined to building or origin tluziber or atcrias'w/ ortrame damage etost or flame spread con tricu00nor<70 5 ❑Heyonfl building of origin 175 to )LOOS f1wne damage) Ll Presence of Detectors * L3 Detector Power Supply L5 Detector Effectiveness (In area of tha fire) Required it detector operated N ❑None Present . Skip to 1 ®Battery only section M 2 ❑Hardwire only 1 Alerted Occupants, occupants responded 1 ®Present 3 ❑Plug in 2 LJOCCupant9 failed to respond 4 O Hardwire with battery 3 []There were no occupante V ❑IInd4t9rminad 5 Q Plug in with battery 4 ❑Failed to alert occupants 6 ❑Mechanical U ❑Undetermi ed LZ Detector Type 7 ❑Multple detectors 6 ' ` power supplies . . L6 Detector, Failure.Reason 1 ( Smoke o Other' ' Required if.detector failed to operate p 2 ❑Heat U[]UndetPrmi•,ed 3 ❑Combination smoke - host 1 ❑Power failure, shutoff, or."disconnect L4 Det®otor Operation 2 ❑=mproppr installation or `placement 4 ❑Sprinkler, water flow detection 1 ❑Piro too small 3 ❑Defective; to activate: 4 ❑Lack of maimtenanCe, ineludee cleaning 5 []Nore than 1 type present 2 aOperated 5 uX BBttexy misS .ng or disconnected' O mother (Con pletm Ssotion L5) 6 ❑Battery discharged or dead 3 ©Failed to Operate 0 ❑Other U❑Undetermined (Complete section L6) V U Undetermined ❑Undetermined M1 Presence of Automatic Extinguishment System * Automatic Extinguishment ] Automatic Extinguishment N ®None Present System Operation Syst4mla Failure Reason - , Required if fire was within assigned range Required if eyetem failed complete rest ❑Present of Section M 1 ❑Operated 6 effective (Go to M4 1 ❑System,shut off _ 2 Type of Automatic Extinguishment system * 2.❑Operated & not effective .(M4) Required if fire was within docignad range:of AM$ 3:E]Flre too small' to activate 2.�Not enough agent discharged 1 ❑Wet pipe Sprinkler 4 Failed to operate (Go to M) 3;❑Agent.dischar4ed but did 2 Dry pipe sprinkler 0 Other not reach fire ❑ 4 ❑wrong type of.system 3 Other Sprinkler system U Undetermined' 5 ❑Fire not in area protected 4 nDry chemical system 6[]System Compon®sits damaged Number of Sprinkler 5 Foam System Heads operating 7 LJLack of maintenance 6.rJ Halogen type system 6 nmanual T-ntervention Required if system operated 7 ❑CarD�on dioxide (CO2) system 0 El Other 0 Other special hazard system U❑Vndetemmi ned U EJUndetermined Neer of sprinkler heads operating 1R9_3 Revision 01/19/99 I `31/MAT/2011/TUE 11 : 49 C-0—MM FIRE DEPT FAX No. 5087902385 P. 008/010 Ldop Up Print Page 1 of 3 . Owner Information-Map/Block/Lot: 251 /030/-Use Code: 1010 Owner Owner Name NASTASIA,KATHLEEN S TR Co-Owner CONKERS 69 NOMINEE Name TRUST Property Address Owner Mailing Address 69 CONNERS ROAD 62 DUNASRIN R17 Map/Block/Lot _ CENTERVILLE MA. 02632 251 /030/ . Assessed Values 2011 -Map/BlockfLot: 251 /030/ Use Code: 1010" 2011 Appraised Value 2011 Assessed Value Past Comparisons Building $ 140,900 $.140,900 Year Total Assessed Value: Value Extra $ 3,000 $3,000 .2010 $ 302,900 Featares: Outbuildings: $ 0 $ 0 2009 -$ 389,500 Land Value: $ 164,400 $ 164,400 2008 -$4007300 2007-$ 399,800 2011 Totals $308490 $308,300 2006 -$ 371,900 . Tax Information 2011- Map/Block/Lot: 251 /030/-Use Code: 1010 Fire District Rates Town Residential Taxes Barn FD-All Classes . $2.31 $8.05 C.O.M.M.FD Tax $410.04 C.O.M:M All Classes $1.33 (Residential) Town Commercial Cotuit FD-All Classes $1.68 Community Preservation Act .$74:45 Hyannis-Residential $2.04 Tax $7.28 $ Hyannis -Commercial $3.24 Town Tax(Residential) �Barnstable -` 2,481.82 $L.65 $ Residential 2,966.31 W Barnstable- $2.34 Commercial . Sales History-Map/Block/Lot:`251 /030/-Use,'-Code: 1010 History: Owner: Sale Date BoolvTage: Sale Price: NASTASIA,THOMAS V Feb 14.2002 12:OOAM C 16431.1 $ 1 NASTASIA,KATHLEEN_S TR Feb'14 2002 12:OOAM C1'64312 $'1 NASTASIA,KATHLEEN S TR Apr 15 1991 12:OOAM C123054 $ 1 httn://www.town.bamstable.mA.us/Assessing/nrint-as»?sea.rchnnree1=951010 5/1f OM.1 '31/MA`S/2011/TUE 11 . 49 0-0—MM FIRE DEPT FAX No, 5087902385 F, 009/010 Loop Up Print Page 2 of 3 NASTASIA,THOMAS V Aug 15 1987 12:OOAM C111807 $ 1 NASTASIA,THOMAS V C6970 $ 0 . Sketches-Map/Block/Lot:251 /030/ Use Code: 1010 5 AsBuilt Card N/A . Constructions Details-Map/Block/Lot:251 /030%-Use Code; 1010 Building Details Land Building value $ 140,900 Bedrooms 3 Bedrooms USE CODE 101( Total Improvements Value $176,125 Bathrooms 1 Full Lot Size(Acres) 0.37 Model Residential Total Booms 6 Rooms Appraised Value $ 16-4 Style Ranch Heat Fuel Oil Assessed Value $ 16• Grade Average Plus Heat Type Hot Water Year Built 1945 AC Type None Effective depreciation 20 Interior Floors Hardwood Stories" 1 Story Interior Walls Drywall Living Area sq/ft 1,632 Exterior Walls Wood Shingle Gross Area sq/ft 2,668 Roof Structure Gable/Hip Roof Cover Asph/F Gls/Cmp • Outbuildings &Extra Features-Map/Block/Lot: 251/030/-Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed.Value " FPL1 Fireplace 1 stogy 1 $ 3,000 $3,000 • Sketch Legend httn://www.town.bamstable.ma.us/AssessinLy/nrintasD?searchDarcel=251030 5/28/2011 -3r/MAY/2011/TUE 11 : 49 C-0—MM FIPE DEPT FAX No, 5087902385 P. 010/010 o Loop Up Print Page 3 of 3 Property Sketch Legend Third Story.Living Area A.OF Office, (Average) FT$ SF$ Base; Semi-Finished (Finished) Second Story Living Area Three Quarters Story BAs First Floor, Living Area FUs Tos (Finished) (Finished) BMT Basement Area(Unfinished) GAR Garage UATe Attic Area (Unfinished) CLP Loading Platform SRN Greenhouse UHs Half Story (Unfinished) CAN Canopy -- MZ1 Mezzanine,UnFxn shed usT Utility Area (Unfinishec FAT Attic Area (Finished) MZ2 Mezzanine, Semi-finished UTQ Three Quarters Story (Unfinished) FBM Finished Basement MZ3 Mezzanine,finished UUA Unfinished Utility Attic FCP Carport PAT Patio Outbuilding Listed Uus Full Upper 2nd Story . (Unfinished) FEP Enclosed Porch PTO Patio WDK Wood Deck FHS Half Story (Finished) REF keference Only WKO Wood Deck Outbuilding Listed FOP Open or Screened in SDA Store Display Area Porch • httn_//wtivvv_town_harnctah1e.mr�uc/Acreccin�/print.aan?cPaxchnarcP1-2.51010 5owoi i i SEP/26/2017/TUE 02: 10 PM COMM Water Dept FAX- No. 5084283508 P. 002 CentervUle-Osterville-Marstons M!Us Water Department P.O.BOX.369 1138 MAIN STREET OSTERVILLE,MASSACHUSETTS 02655 www.commwater.com ¢' � OFFICE OF WATER �► BOARD OF WATER COMMISSIONERS WATER SUPERINTENDENT DEPT. TEL.No.508-42"91 DNS FAX.No.508-428-3508 September 26,2017 Bamstable,Town of Building Department 200 Main Street Hyannis,MA 02601 ,} Re: Account 42485 Dr. Thomas V.Nastasia 69 Connors Road Centerville, MA To Whom It May Concern: On Tuesday, September 26, 2017 the water service was turned off, the water meter pulled and disconnected the water service at the water main for the property mentioned above. It is our understanding that owner plans to demolish the house and will install a new water service at a later date. If you have any questions;please call our office at 508-428-6691. -V ery truly s, Crai Crocker Superintendent CC/jw FiA �a e Town of Barnstable i Regulatory Services wa. Thomas F.cider,Dlr h,r . ao xdF� _ Building Division ' Thames Perry,CBO,9.11d[ag fgmm$si Z09 Main Sleah Hyannis,MA 02601 - wuw.rolra.6armhhle.me.m - - . Office:500-962-4019 - Fax:508-790-6230 PLEASE FORWARD THE ATTACHED PAGE(S)TO: To: C OK k--Q_ ATTM q 7 RE; ` FROM: DATE: LP lA PAGE(5); ([NCLUDINGCOVERSIIEE1) - Rcv:lileal - azis iiew_3 :•xew PeP99Ox3 (5 '3 uoi }Dauu03 allwlsa'e} ON (b '3. aaresule ON. (E '3 Asng (Z '3 (..iE} auii ao do 2UVH ..({ •3 aoaea AO} uos'eay ---------------------------------------------------------------------------------------------------- N0 E 'd S80Z06120Sl6 XI' AAIWIN 0020 ---------------------------------- —----------------------------------------------------------------- }uaS ION j lnsad (s) d uol �u l sa0 apOW 'ON a��d acid AdEti E. ll06 g unr ;ami jp;; 0 (z (l ( WdWti [rOZ _'9 'un0 ) .Jjod;d Ipsad uoll`ealunwwoo 'd SENDER: COMPLETE THIS SECTION EMMM"Mulvil-LEI E'THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A Signature Item 4 if Restricted Delivery Is desired. o ' �� �^ ❑Agent ■ Print your name and address on the reverse X1:C�L(,tGCu ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C.,Date ery ■ Attach this card to the back of the mailpiece; l/Ji orCn the front if space permits. /G,Q I= 1VT G l i. �, D. Is delivery address different from Item 1? ❑Yes 1. 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Please print your name, address, and ZIP+4 In this box TOWN OF,BAR STABLZ DUUMO DI VISM Ii WMAMMMAMMOL i ��iE11Ft�ttti7?ti�i:tiEi?li?1i1?�l?.tF?3fE3t:iEl��tlF�ii!!iltil� U.S. Postal ServiceTM CERTIFIED MAILTM RECEIPT _, (Domestic flRail10nly, o Ms,—e Coverage Provided) ffFor,d61i very,iiiformation,visit our website at www.usps.com� i PS_Forff 3800 June 2002 See Reverse for Instructions i Certified Mail Provides: (--eu)zoo&sunr'ooss uuoj sd. 0 A mailing receipt • A unique identifier for your ma*rteco-,-4., a A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. o Certified Mail is not available for any class of international mail. • NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS9 postmark on your Certified Mail receipt Is required. - •For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". d If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt Is not needed,detach and affix label with postage and mail. IMPORTANT:save this receipt and resent it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. iy THE Town. of Barnstable I 1 Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www-town.ba rnsta ble.ma.us Office: 508-862-403 8 Fax: 50 8-790-623 0 Tomas and Kathleen Nastasia 62 Dunaskin Rd Centerville, MA 02632 Re: 69 Conners Road, Centerville, MA Dear Mr. or Mrs.Nastasia; On Saturday, May 29, 2011, the Centerville-Osterville-Marstons Mills Fire Department (COMM FD) called me over concerns they had after responding to a small kitchen fire at the above referenced address. I have made multiple attempts to reach you-at the telephone number provided to me by COMM FD without avail. Pursuant to 527 CMR 12.0, I am sending you this letter. After visiting the tenants at the above address, and the facts given to me by the fire department, I have found that the range oven cord was incorrectly ran through the floor, and no electrical outlet exists behind the range for it to correctly plug into. This must be completed by a licensed electrician, and permitted by the Town of Barnstable in accordance with Massachusetts.General Law. Additionally, I found the following: 1. An abandoned electric range cable located in the ceiling of the basement was left improperly terminated and found to be energized by COMM FD at.the time. This + is an IMMENANT DANGER to persons residing within the dwelling, some of which are children. 2. An over-use of electrical splitters in the basement exists, which is a fire hazard. Electrical extension cords and multi-outlet splitters pose a risk of fire when their respective maximum wattage 'ratings are exceeded. Pg. i of 2 3. An electrical receptacle located at the electric panel, and a light switch located at the top of the basement stairs has no cover plate. Cover plates are intended to create a limited fire barrier between the electrical components and surrounding combustible materials, as well as reduce the risk of electrical shock. 4. There is a dryer receptacle with a supply cable entering a hole with no protection from its sharp edges. This poses a risk of fire. In the interest of public safety,please address these issues without delay. I can be reached at the above address if you have any questions. Sincerely, AS AJ Pulley, Deputy Wiring Inspector C: COMM FD Health Dept. Wiring Inspector Residents of residence Q:\WPFILES\A.J.PULLEY\69conners2011AJElectrical.doc Pg. 2 of 2 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424 6/1/2011 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.313 BARNSTABLE BUILDING COMMISSIONER 367 MAIN STREET 367 MAIN STREET HYANNIS MA 02601 Re: Insured: THOMAS NASTASIA Property Address: 69 CONNORS RD.,CENTERVILLE,MA 02632 Policy Number: 090670T Type Loss: Fire(including Fire caused by Lightning Date of Loss: 05/28/2011 Claim Number: 289053 Claim has been made involving loss,damage or destruction of the above captioned propert,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139 Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. 0 O MPIUA Claims Division Q • c t CMA00021 } T .��t► r0ti Town of Barnstable ` Regulatory Services BARNSTABLE, • - . MASS. Thomas F. Geiler, Director rFa �b 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 PLEASE FORWARD THE ATTACHED PAGE(S) TO: TO: —C' O K M -- c ATTN: FAX NO: � RE: FROM: V DATE: PAGE(S): (INCLUDING COVER SHEET) z r 1 t Rev:121901 i oFTKE Tow n of Barnstable, Regulatory.Services Mess. Thomas F. Geiler,Director i639. 'Eo►�+' Building Division Thomas Perry,Building Commissioner 200 Main Street,-Hyannis,MA 02601 www.town.barnstable.ina.us Office: 508-862-403 8 -Fax: 508-790-6230 Tomas and Kathleen Nastasia., 62 Dunaskin Rd Centerville, MA 02632 Re: 69 Conners Road, Centerville, MA Dear Mr. or Mrs. Nastasia; On Saturday, May 29, 2011,the Centerville-Osterville-Marstons Mills Fire Department (COMM FD) called me over concerns they had after responding to a small kitchen fire at F the above referenced address. I have made multiple attempts to reach you at the - telephone number provided to me by COMM FD without avail. Pursuant to 527 CMR 12.0, I am sending you this letter. After visiting the tenants at the above address, and:the facts given to me by the fire department, I have found that the range oven cord was incorrectly ran through the floor, and no electrical outlet exists behind the range for it to correctly plug into. This must be completed by a licensed electrician, and,permitted.by the Town of Barnstable in accordance with Massachusetts General Law. Additionally, I found the following: 1. An abandoned electric range cable located in the ceiling oftthe basement was left improperly terminated and found to be energized by COMM FD at the time. This is an IMMENANT DANGER to persons residing within the dwelling,some of which are children'. 2. An over-use of electrical splitters in the basement exists, which is a fire hazard. a Electrical extension cords and multi-outlet splitters pose a risk of fire when their respective maximum wattage ratings are exceeded. Pg. l of 2 3. An electrical receptacle located at the electric panel, and a light switch located at the top of the basement stairs has no cover plate. Cover plates are intended to create a limited fire barrier between the electrical components and surrounding combustible materials, as well as reduce the risk of electrical shock. 4. There is a dryer receptacle with a supply cable entering a hole with no protection from its sharp edges. This poses a risk of fire. In the interest of public safety,please address these issues without delay. I can be reached at the above address if you have any questions. Sincerely, J� l � AJ Pulley, Deputy Wiring Inspector C: COMM FD Health Dept. Wiring Inspector Residents of residence i Q:\WPFILES\A.J.PULLEY\69connersZ011AJElectrical.doc Pg. 2 of 2 'hoop Up Print Page 1 of 3 OWtJER; . Owner Information-Map/Block/Lot: 251 !0301-Use Code: 1010 I�on 1�ecs as� a Owner Owner Name NASTASIA,KATHLEEN S TR Co-Owner CONNERS 69 NOMINEE T,&J.4AiT Name TRUST Property Address Owner Mailing Address ' 69 CONNERS ROAD 62 DUNASKIN RD CENTERVILLE, MA. 02632 t Map/Block/Lot 251 /030/ . Assessed Values 2011 -Map/Block/Lot: 251 /0301-Use Code: 1010 2011 Appraised Value 2011 Assessed Value Past Comparisons Building $ 140,900 $ 140,900 Year, Total Assessed' Value: Value Extra $ 3,000 $ 3,000 20.10 - $ 302,900 Features: Outbuildings: $ 0 $'0 2009 $ 389,500 Land Value: $ 164,406 $ 164,400 2008 - $400,300 2007 - $390,800 2011 Totals $308,300 $308,300 2006 $ 371,900 . Tax Information 20117 Map/Block/Lot: 251/0301-Use Code: 1010 Fire District Rates Town Residential Taxes Barn FD-All Classes $2.31 $8.05 C.O.M.M.FD Tax $410.04 C.O.M.M-All Classes $1.33 (Residential) Town Commercial Cotuit FD-All Classes $1.68 Community Preservation Act $ 74.45 Hyannis -Residential $2.04 Tax .$7.28 • $ Hyannis-Commercial $3.24 Town Tax(Residential) 2,481 82 W Barnstable= Residential $2.65 2,966.31 W Barnstable- $2.34 ' Commercial . Sales-History-Map/Block/Lot: 251 /0301-Use Code: 1010 History: r • Owner: ' Sale Date Book/Page: . Sale Price: NASTASIA,THOMAS V Fell 14 2002 12:OOAM C164311 $ 1 NASTASIA, KATHLEEN S TR Feb 14 2002 12:OOAM C164312 $ 1 NASTASIA, KATHLEEN S TR Apr 15 1991 12:OOAM C123054 $ 1 http://www.town.bamstable ma.us/Assessing/print.asp?searchparcel=251030 5/28/2011 Loop Up Print r Page 2 of 3 NASTASIA,THOMAS V . Aug._15 198712:00AM C111807 ~ $ 1 NASTASIA,THOMAS V C69713 $0 . Sketches-Map/Block/Lot: 251 /0301_Use Code: 1010 4'.7, � S i y M . AsBuilt Card N/A . Constructions Details-Map/Block/Lot: 251 /0301-Use Code: 1010 Building Details 'Land Building value $ 140,900 Bedrooms . 3 Bedrooms USE CODE 101( Total Improvements Value $176,125 Bathrooms 1 Full' Lot Size (Acres) 0.37 Model Residential Total Rooms 6 Rooms Appraised Value $ 164 Style Ranch - Heat Fuel Oil Assessed Value ' $ 16. Grade Average Plus Heat Type Hot Water Year Built 1945 AC Type None Effective depreciation 20 Interior Floors Hardwood Stories 1 Story Interior Walls Drywall ,Living Area sq/ft 1,632 Exterior Walls Wood Shingle Gross Area sq/ft 2,668 Roof Structure Gable/Hip Roof Cover AsplvT GIs/Cmp . Outbuildings& Extra Features-Map/Block/Lot: 251 /0301-Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value FPL 1 Fireplace p ce 1 story 1 $ 3,000 $ 3,000 . Sketch Legend http://www.town.barhstable.ma.us/Assessing/Print.asp?searchparcel=251030 5/28/2011 f ti �F r :. _ �x�� .:�� �� ,fir « � '►a r. u. F a y�. »� *" 64 a T I�F00 - wi L�,,•� s r +i r: EI1FC4C�+Yi It J r a c , v ' i" i' ,p �,, (P�1rJ� � emu-/' eJ.�S'r✓✓�-i/L C f lliv Sv�P01ZTes1� �.M295 �t✓L^fr�t v� L TL 1 Sr�.1 C�/LD S / too >� �cct�s,tlSc . f1AivGt; AA) Cathi -771-,e�&,l r�✓LJi�w„�✓� 05/31/2011 15:28 TOWN OF BARNSTABLE IPG 1 , permit APPLICATION PROFILE- piappent GENERAL APPLICATION ------------------- Application ref 20065272 Fee Effective Dt 12/14/2006 Department -BUILDING DEPARTMENT Location 69 CONNERS ROAD Parcel 25103'0 Cross streets Add'l loc desc LOT 22 Municipality CENTERVILLE Subdivision LotO Existing use SINGLE FAMILY HOME memo - Current Zoning RESIDENCE D-1 DISTRICT Flood zone Applicant GAS CONTRACTOR Proj/Activity GAS RESIDENTIAL Class of work //OTHER Description lRANGE-,-HEATI-NG-BOI-LER-AND WATER HEATER AND-TESTS , Proposed use SINGLE FAMILY HOME memo Proposed zoning RESIDENCE D-1 DISTRICT Flood zone Non-conforming N� Applic received-�12/14/06 Estimated cost — - 0 Estim start/end Actual start/end Impervious Surf - Assigned to Status ACTIVE Status code "desc ACTIVE.APPLICATION Multiple submissions N - Next action Government owned N memo Ordinance ref Reason for app Parent app Point in time fee effective date Fee expiration date ROLES/NAMES Role Name/Address PROPERTY OWNER NASTASIA, KATHLEEN S TR CID 172905 62 DUNASKIN RD CENTERVILLE, MA 02632 . GAS CONTRACTOR G. W." HALLETT & SON CID : 811972 417 FALMOUTH RD. Phone: (508)776-5395 HYANNIS, MA 02601 Tradesman Name Lic Type License number Class NAICS Expires G. W. HALLETT & SON - JEF MSTR PLUMB 9672 05/01/12 05/31/2011 15:28 TOWN OF BARNSTABLE PG 2 permit APPLICATION PROFILE piappent Application ref: . 20065272 (continued) PREREQUISITES ------------- Prereq Action Dept Needed By. .Approved By Status - WORK COMP SUBMISSION 6300 12/14/06 SSHE APPR 12/14/2006 PERMITS Type Permit Number Status Issued Fee Unpaid Amt RES GAS 20061004 ISSUED 12/14/06 61.00 .00, AUDIT HISTORY ------------- DeYaitiient Action Source Created by Date Comments " BUILDING DEPARTMENT EXCEL 2006 GENERATORS• APP • finchn 10/25/10 BUILDING DEPARTMENT- EXCEL 801-GAS 9/1/10 „APP, finchn 09/01/10 BUILDING DEPARTMENT GAS ROU 1 APP burnhamr O1/12/07 12/14/2006 PASSED INSPECTION BUILDING DEPARTMENT Permit issued APP sheas. 12/14/06 Permit 'no 20061004, Permit type RES GAS, PAID BUILDING DEPARTMENT Permit payment collected APP sheas 12/14/06 Payment collected on permit RES GAS PERMIT,,G BUILDING DEPARTMENT Prerequisite approved APP sheas 12/14/06 WORK COMP on 12/14/06 BUILDING DEPARTMENT Application entered. APP sheas 12/14/06 BUILDING DEPARTMENT New plan review started. APP sheas 12/14/06 Plan review number 00 was created. ** END OF REPORT - Generated by Permit Counter User ** w A 05/31/2011 15:28 TOWN OF BARNSTABLE PG 1 permit APPLICATION PROFILE Ipiappent GENERAL APPLICATION-------------------- - Application ref 200652,73 Fee Effective Dt 12/14/2006 Department BUILDING DEPARTMENT Location 69 CONNERS ROAD Parcel 251030 Cross streets Add'1 loc desc . LOT 22 Municipality CENTERVILLE Subdivision LotO Existing use SINGLE FAMILY HOME memo Current Zoning RESIDENCE D-1 DISTRICT Flood zone Applicant PLUMBING CONTRACTOR Proj/Activity PLUMBING RESIDENTIAL Class of work OTHER _ Description77 HOT^WATER TANK AND_BACKFLOW PREV �" Y fi. Proposed use SINGLE FAMILY HOME memo Proposed zoning. RESIDENCE D-1 DISTRICT Flood zone Non-conforming N Applic received 12/14/,06 Estimated cost 0 Estim start/end `Actual start/end 12/13/06 Impervious Surf Assigned to Status COMPLETE Status code desc CLOSED APPLICATION Multiple submissions N Next action Government owned N memo Ordinance ref Reason for app Parent app Point in time fee effective date Fee expiration date ROLES/NAMES Role Name/Address PROPERTY OWNER NASTASIA, KATHLEEN S TR CID : 172905 62 DUNASKIN RD CENTERVILLE, MA 02632 PLUMBING CONTRACTOR G. W. HALLETT & SON CID 811972 417 FALMOUTH RD. Phone: (508)776-5395 HYANNIS, MA 02601 Tradesman Name Lic Type License number Class NAICS Expires G. W. HALLETT & SON - JEF MSTR PLUMB 9672 05/01/12 05/31/2011 15:28 TOWN OF BARNSTABLE PG 2; permit APPLICATION PROFILE Ipiappent Application ref: 20065273 (continued) PREREQUISITES ------------- Prereq Action Dept Needed By Approved By Status WORK COMP SUBMISSION'., 6300 12/14/06 SSHE APPR 12/14/2006 _. PERMITS Type Permit .Number, Status Issued Fee Unpaid Amt RES PLUMBI 20060792 ISSUED 12/14/06 37.00 .00" AUDIT HISTORY------------- - Department Action Source Created by Date Comments BUILDING DEPARTMENT EXCEL 801-GAS 9/1/10 APP finchn 09/01/10 BUILDING DEPARTMENT PLUM FIN APP . burnhamr 02/16/07 12/13/2006 PASSED INSPECTION BUILDING DEPARTMENT ' Permit issued APP sheas 12/14/06 Permit no 20060792,. Permit type RES PLUMBI, PAID BUILDING DEPARTMENT Prerequisite approved APP sheas 12/14/06 WORK COMP on .12-/14/06 ` BUILDING DEPARTMENT Permit payment collected . APP. sheas 1-2/14/06 Payment collected on permit RES PLUMBING PERMIT P BUILDING DEPARTMENT Application entered. APP sheas' 12/14/06 BUILDING DEPARTMENT New plan review started. APP sheas 12/14/06 Plan review number 00 was created. ** END OF REPORT Generated by;Permit Counter User ** 05/31/2011 15:29 TOWN OF BARNSTABLE PG 1 permit APPLICATION PROFILE piappent GENERAL APPLICATION ------------------- Application ref 51868_ Fee Effective Dt 02/26/2001 Department BUILDING DEPARTMENT Location. 69 CONNERS ROAD Parcel 2S1030 Cross streets Add'1 loc desc Municipality CENTERVILLE Subdivision -Lot Existing use SINGLE FAMILY HOME memo s Current Zoning RESIDENCE D-1 DISTRICT Flood zone Applicant •Proj/Activity ELECTRIC RES. ADD/ALTER Class of work OTHER. _..�... -- Description CHANGE_FUSE_PANEL/METER SOCKT°`CH""82'9T{°PART) Proposed use SINGLE FAMILY HOME memo ., Proposed zoning RESIDENCE D-1 DISTRICT Flood zone Non-conforming N Applic received 02/26/01 Estimated cost 0 Estim start/end 02/26/01 Actual start/end -02/28/01 Impervious Surf Assigned to Status COMPLETE Status code descc -CLOSED APPLICATION Multiple submissions,N - Governmentw N o ned Next n e t actin memo Ordinance ref - Reason for app Parent app Point in time fee effective date Fee expiration date - ROLES/NAMES Role Name/Address PROPERTY OWNER NASTASIA, KATHLEEN S TR CID : 172905 62 DUNASKIN RD CENTERVILLE, MA 02632 GENERAL CONTRACTOR COLEMAN ELECTRIC CID : 810856 62 FLEETWOOD PATH Phone: (508)428-7445 MARSTONS MILLS, MA 02638 Tradesman Name Lic Type License number Class NAICS Expires COLEMAN ELECTRIC A15632 z 05/31/2011 15:29 TONTN, OF BARNSTABLE PG .2 permit (APPLICATION PROFILE IP.iappentA#: Application "ref': 51868 (continued) PERMITS Type Permit Number Status Issued Fee ' UnpaidRAmt 'E, PENT `CNV. 51868. ISSUED• 02/26/.Ol 36.00" 00.. ** ENDOF „REPORT - Generated. by Permit Counter User'** y r ~ t r.. � y [� .V.; /.G. �� '.i • I � ' �.. S . .._ _. _.. V..`� _. /.�. . 69 Conners Road 002 69 Conners Road 0.03 69 Conners Road 004 Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. This email has been checked for viruses by Avast antivirus software. https://www.avast.com/antivirus y � Y 2 110 MPH EXPOSURE S WIND ZONE' i Anchor Bolt and Uplift 3"x 3"x 1/4" Plate Washer Wall Stud Lateral . Shear Bottom Plate- Bottom i , ;0. , Plate See Table 4 AncFior; 7" min. Vi , Sill Plate =a Steel Strap Lapped Under SIII Plate � 2"from Endue of Plates Foundation Wall . Anchor Bolt and Uplift ' Wail Stud 3"x 3"x 1/4" Plate Washer Lateral Bottom P.,late Bottom Shear AnchorBolt Plate See Table 4 ,y G i F` "� s `1''''A^. '_' 3 � sr� �s Lp�iX3' •. .,,> �d�'f .bra . 15" FloorJolstec� l g min. Sill Plate Steel Strap Lapped Under Sill Plate from End " •�i'�tW aC 6 i y J of Plates r'xY;a Anchor Bolt and Uplift VM'Stud 3"x 3"x 1/4" Plate Washer Shear Bottom Plate s under s 7 1 • � ��.� ra`�. rt� a � �,. � ,.ate :.'., � '�'" . 60-12m from End r Of Plates Figure 5 Bob Rasntmg t d 2.3 ANCHORAGE AT OPENINGS 4ddmonaI EmdkwW shiffl be of m Tn • = to r' st 0a S in Tabte 9 tpage 16 and 17). 110 MPH EXPOSURE B W1111D ZONE and Uplift Plate Washer Wall Stud Lateral Shear Bottom Plate See Table 4 Anchor<9olt i r �, Y•' 7® min. Fo orJo t i aR 9 Sill Plate C Steel Strap Lapped Under a " � �;��.#� ,� �4�# �• _ < L SIIIPlate Foundation Wall = C a Uplift• a and Wall Stud ' Plate Washer Lateral BottomPlete See Table 4 Shear AnchorBolt 5� r � _.'�� .��, �at'� /.;�i, �. o � t' FICCrti°JOIStr"��rt'• L."7` l.." �bA& �' `•� min. SIII Place � 4 Steel Strap Lapped Under •,'��� � � �� �° �' �5f�. X �� � Sill Plate �« 64 I S. s - y��;r - qr• r u End r and Uplift Was S " Plate Washer w.,�. : - ti„ .• ;x 0, Lateral Shear _ r3 Under PW t- Elie[ 4��i +'Hz:F+R 1 ° I CHOR GE AT OPENINGS i xbonqc shag be msm3td of cg=ng ro the in Tatxle 9(page 16 and 17). Wianno Realty From: William Alex [wlja51@metrocast.net] Sent: Tuesday, May 08, 2018 9:32 AM To: Wianno Realty Subject: Re: Emailing: 69 Conners Road 001, 69 Conners Road 002, 69 Conners Road 003, 69 Conners Road 004 Good Morning Jim, Good to hear from you again. We expect you will use a double pressure treated sill. You should counter bore about 3/4" deep on the top sill so the nut can be recessed below the top of the sill. I would have the anchor bolt stick out at least 3 1/2" above the top of wall and then cut off the remainder of the bolt after the nut is secured. I.f any of the bolt is above the ^sill it would interfere with our double perimeter, joists. Please let me know if I can be of any other help. As a side note, I will be out of .the t office from the 17th - 31st of May. I will be back in my office on June 1st. Thanks, Bill -----Original Message----- From: Wianno Realty Sent: Monday, May 07, 2018 5:18 PM To: 'William Alex' Subject: Emailing: 69 Conners Road 001, 69 Conners Road 002„ 69 Conners Road 003, 69 Conners Road 004 Bill, Enclosed please find photos of the block foundation repairs (almost completed) for the Nastasia ranch. As you may remember this is the home that had fire damage, we removed the structure. Upon the conpletion of Razeing of the. building the unusal cold wteher came in and left us unable to repair or rebuild the block foundation. This week we hope _to get final measurements of the foundation and 'convert those to the house plan designs by Steve Cook of Cotuit Bay Design, then we would be prepared to enter a contract with KBS. The structural Engineer wants us to fill the block foundation 4ft on center and cement in place 15 inch anchor bolts. My question if the engineer wants me to cement the anchor bolts a depth of 15 inches into the block what is KBS expecting for a• p:`essure treated plate? Additionally how much anchor bolt should be protruding above the plate? Please let me know a's T will setting. Anchor Bolts at the end of this week. Regards Jim , P.S. : The Town Historic committee disallowed the razing of my Sisters Antique House, But the Building Commissioner will condem the home for demolition with a Structural Engineers Report. Slow, Slow, -Slow approach , but we are gaining. Your message is ready to be sent with the following file or link attachments: 69 Conners Road 001 1 / r ' r"z. r.<3 K ;:rs " ,;•+- i 'n_J. c+a'%^"�.�. 1 a 4 ' ,+,.! ° '`^`il t. '� -� { '�,+_� -3 v ~ { t' - .•s,f 8:. ,J �y Fri s-. "'kkk,�::.. ''� ' '- k 9 � '� a•€x,�t•. ter `,- yF �`.`�,�,.• 'fly+ i., 3�Y .t, �y s��� �"y �".�j .n. ,.�.., - �... .. �, w..,..;w,.,��, 'r,a r -y—;�•�,,.,,•_..•_ 'P .: ' L:. ,�'.,*a, r. 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" � "S�}'�!"�`� a r•t°' .'wl� ��t'.eJ.��' }"'�� � �,' �,`+�ee�:ia. � �� ✓ ���� '���`_��� �« '�. _ �. � Y..r r"c .+n'"�.c-L.,f•�� -:r ✓ 'Tn`Z r°�'.�.�,Y''k''o-'• p*^,a- - " _ '�,,4 �''•r ur*/ �r `• r'"� �:-.,.s'�'i"� � xrr. - a�'•��-c.-ho- '�t'��C -a-_" a yr 9 . - �>�a. rat(!�'� ,. �< '+�� .r. 'p.?�, . rY4"y' x*``fir �."err' •4'�", ', ;T i i ••. ����r: �� r kid ri__'�s, - ' r r ` y QQ , �o� \ Town of Barnstablee i ing ii. I-' Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept 654�0� Posted`Until Final Inspection Has Been Made. \Fo Where a Certificate of Occupancy is Required, such Building shall Not be Occupied.until a Final Inspection has been made. P le r mit Permit NO. B-17-4064 Applicant Name: TRI-S DEVELOPMENT CORP. Approvals Date Issued: 11/30/2017 Current Use: Structure Permit Type: Building-Demolition Expiration Date: 05/30/2018 Foundation: Location: 69 CONNERS ROAD,CENTERVILLE Map/Lot: 251-030 Zoning District: RD-1_ Sheathing: Owner on Record: NASTASIA,KATHLEEN'S.TR Contractor Name: TRI-S DEVELOPMENT CORP. Framing: 1 Address: 62 DUNASKIN RD Contractor License: 170270 2 CENTERVILLE, MA 02632 Est. Project Cost: $ 10,000.00 Chimney: Description: Remove.Fire Damaged Structure From Foundation. 'Permit Fee: $ 125.00 Insulation: _ Project Review Req: Demolition due to fire- Permit contingent upon compliance Fee Paid: $ 125.00 with Zoning Ordinance c. 240 sect. 95 Date: 11/30/2017 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and.changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This-permit shall be displayed in a location clearly.visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all,applicable signatures bythe Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7. Final Inspection before Occupancy Low Voltage final: Where applicable,separate permits are required.for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the'various stages of construction. Final: "Persons contracting with unregistered.contractors do notfiave access to the guaranty.fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site. Final: All Permit.;Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION - Map � � Parcel Application Health Division Date Issued, i[ .30 / Conservation Division Application F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board - Historic - OKH _ Preservation/Hyannis Project Street Address '5' 00 h n -e f c�c! Village 4 e r v r)I le 04 A, - 0 CJ,2 r red v1 -1STeS 1 i4 v, ws+eE' Owner Coheirs RoA novwnre i(_.S- Address Telephone S 6 Sr S' S- aZ 4 i c,da P-1 b. "J � � D.0 h�S K � 2 0�t p 3 fPtyfe`villr LAAA• 6aCS'07 Permit Request � *_VI O V-e- Fite i7 4-M A 9 L a S"�V v c �v d .e � o,%-- � C� A 14 A- Square feet: 1 st floor: existing proposed 2nd floor: existing. proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valua Oo,G aZl Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new 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 of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use -- i --..-. -- -APPLICANT,INFORMATION- - (BUILDER OR HOMEOWNER) Name S'c a •+ Telephone Number Sa'rf ?3 ? -c�)T Ca Address 70 b c ig v Akc.1,. ko!j, License # (S ` G G S A 1 � GS 4 ,e le WA 4. o d 5- Home Improvement Contractor# f 7 6 .97 6 Email Worker's Compensation # IN r C Soa,ro o ? 1'/? ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO .<4; ( (,r SIGNATURE DATE �� /� ��7 h n 1i FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED 'MAP/ PARCEL NO. ADDRESS VILLAGE OWNER Y, DATE OF INSPECTION: FOUNDATION i FRAME INSULATION s x FIREPLACE ELECTRICAL: ROUGH FINAL 't PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL `i FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. f 1 .I' 171C Conlazonprealth of-Vasslachusetts Deparaffmt ofr4drLstriatAccidents �► _ :. affrre offm stigaadens ; t` 600 FPasliirrgloxa Street Boston,41A 0ZII1 -' nwinmas&g- vfdira Workers' Catnpensat on InsuranceAfbdavi Bu lders/ContractQrrs�'EIecfi ciansJFlu nbers Applicant Whri of on Please Print I,esibIy Name tBnsiIIee� , aniaationllndividmi TY-i- -5 Luc I O -P yk,& o e - Address: Cityf tatel nS -r r v`o I f 'wtq', 6�tPllone 7 3 7 7' 6 Areyou an employer?C eckthe appropriate bow:I_&1amType of project(regnired)c a employer with / 4- El am a general contractor and I employees(full andlor part—time)-* have lvreti.the sub-contractors 6- E]New construction ._ 2.❑ I am a sole proprietor orpartner listed on the attached sheet. I El Remodeling s• and have no employees.gees. These sub-can�tractors have. . �P P� $_ Demolition worizing for in any capacity. employees and have wodcers' JNa worioers'comp_insurance: comp.insuncera $ "` _ 9. Building addition eguir 10: Electrical r r ed_ - - 5.:� ��fJe are a corporation and its ❑ epaiis.or additions officers have exercised their 3.❑ I am.a homeoumer doing all work . , �, l l.0 Plumbingrepairs or adtiitions r t�self[No workers'comp- Sight of exemption per MUL ` +11 E]Roofrepairs msurance required,]i % c.152,§1{4X andwe have no, e employees.[No workers' 13.❑Other comp.insurance required.) 'A.ay SWHCatt5at checksbox ifl nmst also fM ootthe sectianbeIowshavdng dheirwaikere compensatia'n policy infozmaua' F ameonraerswho submit this aftidat iadirating thv_y are doing allwaI andthenbke outadecontmcftym—st submitanewaffidavk indicating sncb_ =C01&MCMrs tTut cbeck this box must attacbed an additional sheet shoumg the nuue of the sub-canUwAo s jmd state whether ar riot these entities have employees.IfthesubtaatractnesIuve empIayees,theymustpmvidetheir umekeo'comp.palicg number. I aman etltpZolwr float is prn drag ltrorke.rs'ct7tigw.risagoit iumiraRce-for 1'z cnip£oy?ees B loov is flte policy a7ed jab site informatiotL Insurance:Company Name:Yk<S B C'k A,�e c1 l� U (A C4f Policy#or Self-ins.Lic.#:_ U.)CL/ S't G. S-O G° 7 y FxpiratiosDate: Job Site Ad tire: 6 '1 ell ki o ti cf , City/StaW2 p: rr n+c r v r'i G a At ich a copy of the workers'compensationpolicydecIaration page(showing the policy number and respiration Failure to secure coverage as,required.under Section 25A of MGL o.157 can lead to the imposition of criminal penahies of a fine up to$1,500:00 and'or one-year imprisonmet as swell as ch it penalties.ia the form of a STOP WORT ORDER nd a fine of up to WO-00 a day against the violator. Be advised that a copy of this statement spay,be fosvwded to the Office of Iuvestigations ofthe DFA far insurance coverage verifxca ion. I do heraby cerli,fJ,rsjcdar the panes arty£pnjaIties afgeriary iii atflrs information prof r abm,e.s bu.e aloof correct , Sitntantnre: Date Phone - 6 7 3 -2 - a-r "a ' Officid use only. Da aibt alrrete in this area,I&be winp£eted by city artomn officaai ti City or Trim n: '" Permitucense# Enuing Authority(cird-e One): ' I.Board of Ned& I Building Department 3.Cityfrovm Clerk 4.Electrical Inspector 5.Plumbing Inspector T 6.Other Contact Person: Phone#: p Information and Instructions M�ccarhusetts General Laws chaptarr 152 regmres all MTIoyers to provideworkers'compensation for their employees. PurMlaattD this StHtr<e,as anplopee is defined as-"-.every person in the service of another under any contact of hire, express or implied.,oral or wditen_" An,employer is defined as"an individual,partnership,associab oiy corporation or other legal entry,or any two or mom of the foregoing engaged in a Joint mtezprise,and including the Iegal representatives of a deceased employer,or the receive trr or astee of an individual,partnership,association or other legal entity,employing employees. However the" owner of a dwelling house having not more ti=three apartraenfr aad who resides therein,or the occupant of the - dwelliag house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or bruldmg apprn�th=to 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 buuildiags in the commonwealth for any applicantwho has not produced acceptable evidence of compliance with the insurance coverage required ' Additionally,MGL chapter 152, §2.5C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the p erfomaance ofpnblic work nn�acceptable evidence of compliance with the instiraace. reqnremenfs of this chapter have Been presented to the contracting aofho6ty." 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(--s)and phone numbers) along with their certificates)of a aurae CB: Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not requimd to cant'workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this at�da:Th maybe submited to the DepaL-Fment of Induisirial Accidents for con�mafon of ins ranee coverage. Also he sure to sign and date+he affidavit The affidavit should be retnmed to ffie 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 ifyou are regmlced to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies shouiId enter their self-i saran ce license number on the appropriate line. City or Town Officials Please be sure tha the affidavit is complete and prfided legibly: The Department has provided a space at the bottom of tjae affidavit for you to fill out is the event the Office of Investigations has to contact you regarding the applicant Please be sure to filll in the peimit/license number which will be used as a reference number. In addition,an applicant that must sabmit multiple pe>mitllicense applications in any given year,need only submit one affidavit indicating current policy inl ration Cif necessary)and wider"lob Site Address"the applicant should write"all locations II (city or town}_'A copy of the affidavit that has b een officially stamped or marked by the city or town may b e provided to the ' applicant as proof that a valid affidavit is on file for fade permits or licenses Anew affidavit must be filled out each year.'dhere a home owner or citizen is obtaining a license or permitnot related to any business or commercial venture (i.e. a dog license or peumit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you is advance for your cooperation and should you have any questions, please do not hesitate to give-m a call. The Department's address,telephone and fax number: ' . 'I7�e�an�an�eaZtt>:of I�lass�clius�l� - ' DegartEaMt c&Industzak Aa-Uents =m of [nve&tkatL0-W 6W Wah VG,,5t=t Bastmt.,MA Q111 Tf,-L 4 617' 7-4900 cxt 406 or 1-877MAS F Fax 617 727 7749 Revised4-24-07 Ma gawdia . r oF'ME Town of Barnstable Regulatory Se s � rvICeS F $ Richaz•d P.Sad4 Dirednr `}�n► '` Bi ding Division z TomrenT,Em1�Comn3issianer 200 Maim Sfreet Hyaffiis,MA 02601 www:townbarnstablem y us', Office: 508-8624038 Fay 508-790-6230 Property Owner Must Complete and Sign This Section If Usiiig AB�rilde , 11 ( f c h S. �l Oa S 4(f S`f i9 ,as Owner of the subject property nPm aiii nnnrP S�<<j S J f rC��S t0 act on=TbebA in all maitPrc relative to-work avffioEzed byt-his bmIding permit application for. • C�� C�6�h�T 1' ,f�o.�-� �P g fc rrr:%/�' �1•�► a a G.?a : - - (Address of Job) ` -1'oolfences and alarms are the zesponsibRiyof the applicant,Pools are not to be filled or i til wd before fence is ' t Oad anal.all final " mspecdrons.are pedom1ed and accepted. ;mat= of Owner s%n=m of Applicant � PiiurName Pr=Name . ,Dam - Q:FOAMS:OW1�tP��SS'IDNPOOIS ,, . Tow of Ra stable Regdatory Services Richard V.Sca%Director , RUffdh3.g biVM0Xt Tom Petry,B`dIdi g Ca.nMx&danrx 200 Mafia.Strect Hydmds,MA 02601 WFPT4 toR' b. rnsbhir ma US Office: 509-962-4.038 Fad 509-790-6230 ' - HOMEOWI�rrrs:nn�t SON • PtnscPtvut ITA'IE: JOB LOCAIIOR szc nnmbcr' [x t '$OMEO•W2�t b. phone Wr�[p&once CUpauENT MAIUNCTADDRESS: cifp/(vFQa ¢ zip coda The current exemption for"homeowners"was extended to inclpde owner-occupied dweIImn of six units or less and to allow homeowners to.engage an individual for hirewho does notpossess a license,ptnvided thatihc owner acts as supervisor_ DIM71TON OF HOIMOWNMR P emon(s)who oyes a parcel of land on which helshe resides or intends to reside,on which t$ere is,or is intended to be,a one or two- fam:Zy dwelling,atfaebtd or detached st uamw accessory to such use and/or farm stud ms. A person who constants more than one toms in.a.two-year peziod shall notbe n,,d&zt;d,a.homc*Vm= such"homcmm '.shaIl submitta fiie Buu''t�Official on afoam acceptable t:o the BmIdmg O$mia],tba t brlshe shaIl be responsible fur aIl sorb wozkperfnrmed umder�e bmZdin�oeznzit (Section 109.L 1) Tho undersigned`horneowncx'ace==responsubiTdy for compliance w&tbr.Stafe Bmldmg Cads and o6et'appEcable codes, bylaws,roles andreg^Tati=_ _ 'Lhe umdrKsignecl-homeowner"ceztifies ihathelshe Mulmstands the Tower ofBamstable Buffibng Depatfzarntm inspection pro ces exluii-emenfs =win andfmt helshe will comply wide.said procedmrs and regoir=e ts- and r Sigpata.afHomcowacr Approval ofBmld"mgOfficial • Note: Three family dwellings conbiamg 35,000 cubic fret or larger wM be regt�ed to comly wish&o St Buul7ding Cods Seddon W.0 CoastMct on rnnfMl_ t y The Code s ia1Ps that: 'Any homeowner performing work for which'a bftffi ing permit is required AA be exempt from the provisions of this section(Section 109-L1-Licensing of eonstmc ion Soper visors);provider)filiat if tha homeowner engages a person(s)for hire to do such vrorl;that such Homeowner shall act as sap ervisor." Macy homeowners who use$iis exemption are umaware..that they are assuming the responsliliities of a supervisor (see Appendix(?,Rnles&Regalafions for Licensing Constraclinn SIIpetvisors,Section 215) This hick of awzr=ess often results in serious problems,p=&ularlp when the homeowwner hires—Trrased persons: Iti thus'��our$Hard cannot proceed against the unTcensed person as if wouId with a Tcen-zed Supervisor_ The homeowner acting as Supervisor is Ultimately responsible. coaimumifi I art of the To cusur a that file homeownrx is&2y aware of hWher responsr7iffi't es,many req�', P permit appliraiion, that the homeowner ce:r fy tbat he&he understands the resrponsiblUl ies of a Supervisor. On ffie last gage. of this issue is a form mrready xsed by several fawns. You may c-m t amend and adopt such a formle cats n.for main your cammUaity. Q��PFII�OBMSLf""�'�^a Pe�itfv�s�HESsdoe Revised 06U 13 November 21 , 2017 To: Thomas Nastasa 69 Conners Rd. Centerville, MA This letter is to notify you thaCthe old gas service located 69_Con6ers Rd. Centerville, MA was cut off at the main on 11/20/17. hisletter DOESoT precl,ude�the�exc atoorhomwner from calling�8'1 1before commencing any work F State law requ rwanyone planning un, derg�rou "ex vat on o k t ho fy locals iatilEities by calling 81�1,toget your underground lines;identified�for,�you=priorto d�oing�any logging The call to 811s�the LA.WRarid must be made in advance�of starsting wo k Tl isconf rrnat o letbter of a gascut off DOES N'OT elieve`Ff'he ezcavatoroffrnakng th call to$11 `'It isa State haw requirement �a If you have any questions please feel free to contact me at 781-907-3664 N ma Gut Gas Connections Contractor nationalgrid Reservoir Woods 40 Sylvan Road.Waltham,MA 02451 (781)907-3664 Centerville-Osterville-Marstons Mills Water Department P.O.BOX 369-.1138 MAIN STREET OSTERVILLE,MASSACHUSETTS 02655 www.commwater.com -- OFFICE OF BOARD OF WATER CONMSSIONERS u WATER i WATER SUPERINTENDENT DE PT. TEL.No.508-428-6691 M9 FAX.No.508-428-3508 September 26,2017 Barnstable, Town of Building Department 200 Main Street Hyannis, MA 02601 Re: Account#2485 Dr. Thomas V. Nastasia 69 Connors Road Centerville, MA To Whom It May Concern: On Tuesday, September 26, 2017 the water service was turned off, the water meter pulled and disconnected the water service at the water main for the property mentioned above. It is our understanding that owner plans to demolish the house and will install a new water service at a later date. If you have any questions,please call our office at 508-428-6691. Very truly rs, Crai Crocker Superintendent CC/jw 08/29/2017 TUE 9:48 FAX 781 441 8765 U001/001 EVERSISURCE 2 Station Olive Wee stwood,Massachusetts 02090 ENERGY August 29, 2017 Thomas Nastasia 62 Dunaskin Rd. Centerville MA 02632 RE: 69 Conners Rd,, Centerville MA 02632 Dear Mr. Nastasia: At Eversource, we're committed to delivering great service. This letter serves as confirmation that, as of 08/29/17, the electric service to 69 Connors Rd., Centerville MA 02632, has been removed, Based on this information, there is no electric power at this address and you may proceed with the demolition, If you have any questions, please contact me at (888) 633-3797. Sincerely, Martin Sullivan `' Electric Services Support Center d S ♦F 1 _ , J F Client#:15130 2TRISDE ACORDty CERTIFICATE OF LIABILITY INSURANCE DArE`nuDD"I"Y) 05/23/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endomemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Dowling&O'Neil Insurance Ag Pxo E 973 lyannough Rd,PO Box 1990 a/Ac FAX Lo 508 775-1620 ac No:5087781218 Hyannis,MA 02601 ADDRESS: 508 775-1620 IN AFFORDING COVERAGE NAIC s INSURER A:a850a0t8a mmma,tm 11104 INSURED INSURER B TRI-S Development Corp. 72 Briar Patch Road INSURER C: Osterville,MA 02655 INSURER D` INSURER E: INSURER F- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSR W VD POLICY NUMBER =CY EFF POLICY EXP UNITS GENERAL UABRftY EpAgCMHpGOECCTURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea am�arertse $ CLAIMS-MADEOCCUR MED EXP(Any ate person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPUES PER: PRODUCTS-COMPIOP AGG $ POLICY �� r LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aaddent ANY AUTO BODILY INJURY(Per Person) $ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS p��ED PROPERTY DAMAGE $ S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIpAS MADE AGGREGATE $ DED dRETENTION$ $ A AM KERSEMPLYERS`I COMPENSATION WCC5005007148 5/01/2017 05/01/201 X WC LIMITS OTH- AND EMPLOYQtS'UABItJTYTORY ANY PROPRIETOR/PARTNER/EXECunVE YIN EL EACH ACCIDENT $5OO OOO ER OFFICER/MEMBER EXCLUDED? � MIA (Mandatwy In NH) EL DISEASE-EA EMPLOYEE $500 000 ITyes.dasdbe order DESCRIPTION OF OPERATIONS below E.L.DISEASE--POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ABaeb ACORD 101,Adddional Remarlm SdteduM,if more apace is required) Ins1rance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. Insurance coverage is limited to the terms,conditions,exclusions,other (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHOR®REPRESENTATIVE 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 Of 2 The ACORD name and logo are registered marks of ACORD #S1912071M191206 NS2 i f Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constrl ti&O§j�ervisor~ CS-065898 'Pi res:07110/2019 SCOTT S SHIELDS ` �s 72 BRIARPAUH RD OSTERVILLE MJ"2655 Commissioner cis,_ ti - ��T p� ✓JJjf` *.J V/ze rpom»�za�zus���aQac�cc//zuae� � � a"•* Office of Consumer Affairs Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Cormation Registration valid for individual use only before the expiration date. If found return to: Re17027h°n x ENWERI[°n Office of Consumer Affairs and Business Regulation 17027U_ 10/03/2019 10 Park Plaza-Suite 5170 TRI-S DEVELOPMEN2=00'RD ; Boston,MA 02116 SCOTT SHIELDS '6' I 72 BRIAR PATCH ROADW� OSTERVILLE,MA 02fi55 Undersecre Not valid without signature �Y 3'�' 17-P INSTALL 51T ANCHOR BOLTS AT fib'c.c MAX. xt'-7 tba '.1, •• FROMr WSSIMI SP HB_ SFARING xPIATES' &tx PLSE OLTIGN BPS 5/63 BEARING PUTES PLACE BOLTS WRHIN 6'-1 S OF NCH FROM END PLACE BOLTS WITHIN 6'-tYOF EACH I OF PLATE OF PLATE CORNER AND TO A B'MINIMUM DEPFN CORNER AND TO DEPTH 1/ INSTALL FIASMUIG UNDER ♦ `` 1 A8 1 HOUSEWRAP a DECKING i ,.___________-____ I DECKING - ff • CONC. APRON fib'ac FLOOR JOISTS U A I w- ig I i .T 2.1 ® o.c a K,Qn P D• 16 DLLs Sao >e INSTALL PEEL 8 STICK I:1 RUBBER M II I I I I [ i BETWEEN LEDOR8 DROPTOPOFFOUNUATION SHEATHING ATDOOROPENINGS SOLIDa 1B1 O°CCKING VW()x Di DO�"eaLOE"EDK SCREWS IT o.c WI ZMAX LUx10 JOISTS HANGERS IA'TT(3)LOCATIONS FRPSON OM HOUSEIZ ON TO DECK JOIST(1)EACH END m I I eE;iac «caFoon«is I I P.Tz.ssluvusEUER P.T.x.esaLv�SCALER TO ATl BELOW GRADE FASTEN JOISTS TO BEAM - I I I I DECK DETAIL W1 SIMPSON Nx.3A TIES iD-r GARAGE A'CGHCRETESLABVB I I ix,�• H 6.6WWFEMBEDDED IT DIA CONCRETE SONOTUBEI SLOPE TOWARDS DOOR I I VJ/v-MA BIGFOOT FOOTINGS C I I UNDERNEATH TO lP BELOW A I �� MUM SIMPSON GARAGE ANCHOR BOLT DETAIL HOUSE ANCHOR BOLT DETAIL i I SCALE:1/2"=1'-0" SCALE:1/2"=1'-W ` \ \ I I I IL------------ ----� I 1 P.T.2.10k®16'o.aC.LEDGER BOARD SCREWELO.D TO I I SCREAG IT oc VR ZMAX LU210)JOLSM HANGERS I A INSTALL SIMPSON DTTIZ TENSION TIES PRAWLSPACE A I I AT(4)LOCATIONS MOM HOUSE TODECK JOIST(1)EACH END 6EYV CON SLAB W/ I I MIL POLY I I I I I N FASTEN JOISTS 10 BEAM VERIFY DECKING W/SIMPSON Hx.MM TIES UP L J WNDDOWFORVE �MESS ,—J e� P.T.2.10lEDGER BOARD SCREWF�TO T INTO CMWKSPACE I P T.3 a 10F SOUD BLOCKING W(x)IFDDERL.OK SCREWS 1Ir 0.c WW ZMAX LU210 JOISTS HANGERS 1 P.T.x.12V INSTALL SIMPSON DTT1Z TENSION TIES AT(A)LOCATKJM3 FROM HOUSE TO DECK I I JOIST(1)EACH END a°our rxlsr.SLAB a SOIL TOACHIEVE A 3W HEIGHT MDV1CONCRETE FOOTINGS BASEMENT r W/7 CONCRETE SLAB W/DER FATHT04V BELOW OW.BIGFOOT FOOTINGS r t I t NEW 36 WDE. 6 6 MIL POLY UNDER Ir �(SRADE.USE SIMPSON ZMAX .� WBASEMENT INDOW 32'HIGH ACCESSI . L 1 J L-J CRAWLSPACE o1 ® oj REMAIN. ""` nBUILDING SECTION DECK "y l "I ro REMAIN.REPaR OR y REPLACE ANY DAMGED FILL Y CMU EXIST.FIREBOX COMPONENTS 1 CMU COMPONENTS A3 I—1 r � b F N A L t J A REMOVE EXIST. NEW CONCRETE tY I h Al ------------------- STEELAAPRO« J J / CONCRETE FOOTINGS I TALLY COLUMNS Barnstable Bldg. Dept. T LIJ 0).1& Ti .Approved by: 9�� — CRAWLSPACE NEW 7 CONCRETE I d ! . 6 MIL POLY UNDER SLAB VJI Permit #: - rI� 11__ FILL AB VERTICAL A'ac e INSTALL VERTITI GWL BARS 1 M L I J TO TOP OF FOORNGTO . STIFFEN WALLS a VEKnCAL INTEGRITY THROUGHOUT THE EXISTING FOUNDATION I USE SIMPSON FVWVa WALL _ 'I? ANGLES AT 3T ac TO HOLD ,7-0' T7-o• OU STRUCTURE TO CONTRACTOR TO VERIFY ALL EXISTING r © SMOKE DETECTOR FOUNDATION WALL DIMENSIONS PRIOR —�— —�— © CARBON MONOXIDE DETECTOR TO PLACING ORDER FOR FACTORY LtJ FILL CMU CORES A7 ALLANDMOR BUILT HOUSE COMPONENTS I BOLT LOCATIONSTHROUGHOUT F 0. FOUNDATION PLAN Y-10' xA'd 6'8 7d THE DESIGNER SHALL BE NOTIFlED IF ANY ERRORS OR OMISSIONS ARE FOUND ON SCALE : 1 DRAWING NO.: NEW W ADDITION/REMODELING FOR THESE EORANGS PRK)RT STRUC OF COTUIT BAY DESIGN. LLCit "�F. IN W ""�PWIHOUTN TM D 1/4 _ 43 BREWSTER ROAD COMM NCES EDRAWNGSIFCO«sTRucnoN 43 BRPEE,MA. 02649 ^�Jy °ESIGNEROFANYERROSOLELYRSOROMISSIONS. CN OF TEDMWER NOTED ANY OTHER ER THE USE PH.(508)274-1166 NASTASIA RESIDENCE 1 9No1 TH THESE DRAWINGS NOTED 9--I—� DATE : FGI �t1 A3 CONSENT OF THE DESIGNER UNDER THE 3/29/2018 62 DUNASKIN RD., CENTERVILLE, MA ASS/prypL COPYRIGHT E��' AARGTC"OTERAL PROTECTON � t ALL WOOD FRAMING SHOWN WILL BE CONSTRUCT EU 12•-0- IN A FACTORY AND INSTALLED ON THE EXISTING j=•y 21'.2- 18� REPAIRED FOUNDATION WALLS.THIS P'eAN IS FOR THE FOUNDATION REPAIR &NEW GARAGE ONLY I 173 �1t S I/ TOP OF PUTS { ... .. - BEDROOM HALL NEW 2-P.T.2 a S SILL S - FI"FL R W/SEALER � xamaNlso.a 2a1a.®1so.a C 1 NEW 4 x e 12 GIRT CRAWLSPACE NEW31?DIA STEEL LALLY COLUMN GARAGE FILL ALL CMU CORES&INSTALL } as VERTICAL BANS AT ST o.c. I j TO TOP OF FOOTING TO I I STIFFEN WALLS a VERTICAL _ I I INIEGRRY THROUGNOUT NEW 9P A 9lP a R- I I THE EKISTING FOUNDATION L—J CONCRETE FOOTING I I USE SIMPSON FWANZ WALL I 1 ANGLES AT 9B'o.c TO HOLD I I ME STRUCTURE TO ME FOUNDATION SILL DECK e A SECTION BEDROOM/HALL MUDROOM A �` Al /> D O b \/ O ° / I I BATH#3 BUILT-IN \® RANGECABINET I cp.� KITCHEN I GAS Y� LIVING __ 15 A"° REF. I I N Bp .m F.P (VAULTED) ... . . _ .. B TOP OF PLATE 2.faa @ 18'o.c I DINING CABINE T T I IBINET r BEDROOM BATH BEAM ABOVE :4 FIRST FLOOR SUBFLOOR xafae®1so.c 2'-ta 1 B !,. NEW T CONC.SLAB w8 Ma POLY CLOS. faBlBleffAM BEDROOM#2 O 1s4r 124r gEW2 CONCRETE SLAB WI a WL POLY UNDER 2r. ' NOTES: /� (� BATH#2 9 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS / 01SE`.'TION Ca—) BEDROOM (r" tt! &DIMENSIONS IN THE FIELD Al CLOS. LEGEND: ' 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, e - CLOS. I DETAILS,&FINISHES IN THE FIELD WITH OWNER Q EXISTING WALLS �4 3.)ALL CONSTRUCTION TO CONFORM TO THE IRC2015 BUILDING CODE CONSTRUCTION TO BE REMOVED FOR ONE&TWO F AMILY DWELLINGS&THE MASSSACHUSETTS 9TH NTS NEW CONSTRUCTION ( EDITIONAM �. 4.) 110 MPH EXPOSURE E B WIND ZONE, 5.) ALL SHEETS OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY, BATH#1 OR HORIZONTALLY W/BLOCKING AT EDGES,3"EDGE/12"FIELD NAILING ALL FLOOR PLAN DETAILS TO BE 6.) ALL LVL LUMBER/BEAMS TO BE 1.9e PED LOAD 0 DEVELOPED BY THE FACTORY & ° �) SEE CERTIFIED E ISTINGPLANETAILS OPED BY WARWICK ASSOCIATES FOR ALL PROPOSED&EXISTING DETAILS BEDRO M#1 8.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL IECC2015 RESIDENTIAL ENERGY EFFICIENCY DETAILS OWNER. ALL DIMENSIONS TO BE SIMPSON COMPONENTS TABLECLIMATEIANEBN. EITHERP I.IIPEPTIVEVALUESORJLbl HICKCEOUIREME TABLE aO2.12 INBAUM PRESCRIPTIVE INSULATION a FENESTRATION REQUIREMENTS VERIFIED BY FACTORY 8c CON TRAC`. O R 9) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS TO BE 3000 PSI ww � arulrE �rA.IE ,ena a �° an aea ev >fl .oN n.oaT ten CLOS. 11 10.)VERIFY ALL PLUMBING&ELECTRICAL DETAILS W/OWNERS ON THE SITE v1i a J i DURING FRAMING CONSTRUCTION I ----- 1.R-VALUES ARE MINIMUMS a UFACTORS ARE MAXIMUMS L 11.)PROVIDE UTILITY INSTALLATIONS FROM STREET TO NEW HOUSE 2WIS MEANS R•15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR VIA UNDERGROUND CONNECTIONS TO COMPLY W/ALL LOCAL CODES OF THE HOME OR R=10 INSULAMON CAVITY AT THE INTERIM OF THE BASEMENT WALL FIRST FLOOR PLAN S 9.REFER TD IECC NSR2016T CHAPTER OUS a FOR ALL IN6U TKN aENERGr REQUIREMENTS DATER R _ a.19.5 MEANS RS CONTINUOUS INSVIATm BREATHING ON THE WALL EIOERK)R a R13 CAVITY INSULATION 21'd fi THE DESIGNER SHALL BE NOTIFIED IF ANY ERRORS OR OMISSIONS ARE FOUND ON SCALE : DRAWING NO.: RE-BUILT HOUSE FOR• OFT- ME6EDRAMANG6DRAIIN PRIOR GS FCNT START UCIO ��® COTUI'T BAY DESIGN, LLC Q C Ib' GGN6,RUGT'DNSIBLEF DING>bNTRIWDR 1/4 1 —0 u ,+-Z/ CON BE CONSTRUCTION FOR THE CONTENT n L R THEM 43 BREWSTER ROAD:.. C MMENC S WI HOOT CONSTRUCTION THE COMMENCES ARMOUR ERRORS T OMISSIONS ME MASHPEE,MA. 02649 ' cru.Ml DESIGNER OF ANY ARE ERRORS OR OMISTHESIONS. DATE c - NA STAS IA RESIDENCE I THESE DRAWNGS REQUIRES S T FOR %IR111 3E Al PH. 508 274-1166 G. DT�E�Lu�LR�6��TTE<+°F ERVILLE, MA , SiQNAL TUNptN(TIRAL E6RGTPFIDMB UNDER 3/29/2018 69 C O N N E R S ROAD CENT ARCH TECTURAL GDPrR GM PROTECTION i ACi OF 1350. Ir � ,T 1-t 12 12 S �S 70 REAR ELEVATION FRONT ELEVATION NEW HOUSE TO BE PLACED UPON EXISTING REPAIRED FOUNDATION ALONG WITH NEW GARAGE FOUNDATION ,2 HOUSE TO BE FACTORY a E BUILT & INSTALLED ON SITE THESE ELEVATIONS SHOWN ARE A REPRESENTATION FOR FOR THE FACTORY TO DEVELOP CONSTRUCTION PLANS RIGH T EL EVATION ,2 QE LEFT ELEVATION THE DESIGNER SHALL BE NOTIFIED IF ANY ERRORS OR OMISSIONS ARE FOUND ON , R E-BUILT HOUSE FOR: THESE DRAWINGS BU R TO START FORTHECONT SCALE : DRAWING NO. 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' W/SIMPSON BPS 6/3-3 BEARING PLATE$ W/SIMPSON BPS 61B3 BEARING PLATES FROM END PLACE BOLTS WIT"IN 6'-1S OF EACH FROM END PLACE BOLTS WITHIN 8'-15'OF EACH 1 7'-3' OF PLATE CORNER ANO TO q 8"MINIMUM DEPTH FLASHING � 1'-3' L � CORNER AND TOAB'MINIMUM DEPTH Of PLATE I INSTALL MOUSEWRAP 80 CNIIIDGR CONC. �_ [ I DECKING •A APRON 1 1 I 1 • '1; — ------ ——— —————— ❑� ❑i FLOOR JOISTS (�. ry I_ -- _-- - —_— _----1 I �p o �0n j P.T.2x 10'c 16'o.c. ,b LL O DROP TOP OF FOUNDATION I I _ INSTALL PEEL 8 STICK n I I I AT DOOR OPENINGS RUBBER MEMBRANE BETWEE SHEATHING ODERB I I I P.T.2 x 10 LEDGER BOARD SCREWED TO I I _ SOLID BLOCKING W//ZZMAX LU2 0JOISSTTSERf1 NGERSSCREWS I NEW S CONCRETE WALLS W/ I I INSTALL SIMPSON TT.TENSION TIES T x 1S CONCRETE FOOTINGS I I AT(3)LOCATIONS ROM HOUSE TO DECK FASTEN JOISTS TO BEAM I I TO 4'n BELOW GRADE I I P.T.2 x 6 SILL W/SEALER n P.T.2.6 SILL W/SEALER JOIST(1)EACH END W/SIMPSON H2.M TIES. q tar tD-r c I j GARAGE ; DECK DETAIL 4'CONCRETE SLAB W/ I f to DIA. I' fix 6 W WF EMBEDDED 12'-0' 24'DIA.BIGFOOT FOOTINGS SLOPE TOWARDS DOOR UNDERNEATH TO 4V BELOW A3- POST 1 GRADE. USE SIMPSON ABUSfi GARAGE ANCHOR BOLT DETAIL HOUSE ANCHOR BOLT DETAIL I I SCALE:1/2"=1'-0" 5'� Ur—=---- -- -- --- I b § P.T.2x 19,@16'o.a I I ( • Y I I BP.T.2 10 LEDGER t �ERAV1/LSD TO )ACE m I' I Al SOLI16'.OBLOCKING W�AREOGERR LO SCREWS I. I 1 I IGERS NSTAL"SIMPSON DTTIZ(TENSION TIESNEW ' D O ST( CONCRETE WI I; I b J �EACHNS H ENOROM HOUSE TO DECK 6 MIL - t FASTEN JOISTS TO BEAM VERIFY DECKING REMOVE BASEMENT UP 4 ".Y WI SIMPSON H2.5A TIES P.T.2x10LEDGERBOARDSCREWEDTO L I WINDOW FOR ACCESS L :� 1 SOLI DBLOCKINGWI(2)LEDGERLOKSCREWS INTO CRAWLSPACE - 16"o.c.WIZMAX LU210 JOISTS HANGERS I: I P.T.2 x tna®i6'o.c. -• INSTALL SIMPSON DTTIZ TENSION TIES - AT(4)LOCATIONS FROM HOUSE TO DECK 1 - I i 1 P.T.2 x 17._ JOIST(1)ECH END' LTO ACHIEVG OUT E AT36'HEIG.SLAB HT 1n DIA CONCRETE SONOTUBEE - i BASEMENT rt� I • WI2'CONCRETESLAB i WE 24'DIA BIGFOOT FOOTINGS BASEMEN NEW 36"VNDE x 88 MIL POLY UNDER� b I UNDERNEATH TO 4'n BELOW fY t WINDOW �_� -+ _.' 32'HIGH ACCESS GRADE.USE SIMPSON ZMAX L 1 J L 1—1 ABU65 POST BASE r �I © ¢� CRAWLSPACE xl �1 © - E3(ISTING CMU WALLS FILL IN EXIST.FIREBOX d RE LACEANY DAROR ( G• BUILDING SECTION �� DECK REPLACE ANY NTS L(7) e WI CMU COMPONENTS O I n I CMU COMPONENTS I - `i , r—� r--I A3 i b A LTJ A - - - 1 REMOVE EXIST. j NEW3nx 30'x 1S ( _ Al '.B APRON CONCRETE FOOTINGS Al • STEEL LALLY COLUMNS 1 I ________ ______ J Dept.1 +-� Barnstable Bld =. LLJ CRAWLSPACE I Approved by: 6✓NEW 2'CONCRETE SLAB W/ JT - 6MIL POLY UNDER r I - r Pei mit #4 /�'I e- i 3a3 w +I+ FILL CMU CORES AT 40'o.c. I &INSTALL N6 VERTICAL BARS J L y TO TOP OOTNGTO STIFFENFFEN WALLS 8 VERTICALINT THE ISTINGROUGHOIJT NDATI THE SIMPSON FOUNDATION USELES AT N FWANZ WALL - F ANGLES ATo.c TO HOLD 12'-0' 12'{T THE STRUCIUSILL THE F°ANDATITNSILL CONTRACTOR TO VERIFY ALL EXISTING + + Q SMOKE DETECTOR FOUNDATION WALL DIMENSIONS PRIOR L t J p CARBON MONOXIDE DETECTOR TO PLACING ORDER FOR FACTORY FIL CMU ES"TALLANCHO THROUGHOUT R BOLT BUILT HOUSE COMPONENTS •J i FOUNDATION PLAN 2'-1n 24'-T 15'-B' 12'-T THE DESIGNER SHALL BE NOTIFIED IF ANY ERRORS* COTUIT BAY DESIGN. LLC THESEDOROMSSPR RTEFTARTON SCALE : (DRAWING NO. BC8 NEW ADD'ITION/REMODELING FOR. THESE DRAW NGS Pq'B`U. STARTOF 43 BREWSTER ROAD 4� haF' qJ� WELL BE RESONSIBLBUILDING CONTRACTOR L — `J" - �. 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THESE DRAWNGS ARE SOLELY FOR THE USE DATE : 62 DUNASKIN RD., CENTERVILLE, MA OF TSETOFT OYMER NOTEDARY OTHER USE OF THESE DRAW NGS REQUIRES THE MR TEN CRTCH TV THE DESIGNER UNDER THE 9/25/2018 ARCHRECTVIULL COPMIGNT PROTECTION .. ACT OF 1650. TYP.ROOF CONST. -xv 10 ROOF RAFTERS a IB'o.c. - .. -518-COX PLYWOOD ROOF SHEATHING - - .. - - - -ABPHAITROOFSHINOLES - .. - -ISLE.FELT PAPER .. .. - .. - .. - .. -11-MYTINSUUTK]N xp-r. 18'O- Y-f.. 170 .. _ - � - � � .. � � .. ®FLATCEIUNGS(R—) .AT ALL RAMER xER HURRICANE CUPS - . f2 IC ALLRAFTER ENDS - . - - -ICE/WATER SHIELD AT BOTTOM G, 9 OF PPRROPAVENN7 BETWWEENRARERS _ A$ .. - .. .. - .WHO WASH BARRIERS - TOP OF PUTE 2 v 10W®1B o.c. 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BUBF10011 NEW B'DATT INSULATION(R30) IyI.. .... .. _ _ _ ,' _ _ NEW U..ER FLAB WO YIL .. . - -POLY UNDERNFATN - .. .. - NEW T CONCRETE SUB W BYIL PoIY UNDER ' - .. - ti 2x'-0 n SECTION @BEDROOM . A4. - 'TYPICAASPHAHINGLEIT ROOF SHINGLES COX PLYWOOD SHEATHING ' I RAPIER IN 15F FELT PAPER TYP.SOLID BLOCKING W THE OUTSIDE. .. - .. - WND WARN LIPS USE SBIPSON Nx9A HURRICANE C TWO RAFTERS BAYS AT N-o.c.. - - - WRIER AT ALL EICERSEE03 SO'LLR RAFTERS SHIELD - gLUMINUMGRIPEOpE 1 a B FASCIA BOARD 1 v S STRAPPING W ' .. .xra l2'GYPSUM BOARD 1 v�SOFFIT BOARD 1•CONT.VINYI SOFFIT VENT ]SOFFIT BOARD TYP.2.S WALLS. 1.31,CROWN S FRIEZE BOARD DETAIL AT WALL .. - SCALE:1/2"=l'-0�' T R SMALL BE NOTIFIED IF ANY - �Q� COTUIT BAY DESIGN, LLC -RE-BUILT HOUSE FOR. RROEBIGNE 43 BREWSTER ROAD THESEDRA ONGSPRIORTOSouNDOH SCALE : DRAVNING NO. THESE DRAW NGS PRIOR TO START OF CONSTRUCTION.THE BUILDING CONTRACTOR 1/4"— 1'-0" .. .. W LL BE RESPONSIBLE FOR THE CONTENT MAS/HPEE,MA. 02649 ` NA S.TAS I A RESIDENCE IN THESEDRAWINGS OF A N E IF CONSTRUCTION C .1 COMMENCESWITHOUTNOTIFYINGTHE PH. 506 274-1166 TH BE RAWNGY ERRORS OR LY FDAOMISSIONS, . QQ OFTEOMERN NOTEDARE. OTHER THE OF DATE : ® � - 6V CORNERS ROAD CENTERVILLE, MA OF THETOFTHEOTEDANY OTHER USE OF /—� THESE DRAWNGS REQUIRES THE WRITTEN LRCHITE TURAL DESIGNER UNDER ROTECTI 9/25/2018 ACT OF COPYRIGHT PROTECTION - - ACT OF 1890. f F.F. ELEV.=75.33 USE RISERS TO BRING THE COVERS TO WITHIN 20'min. RISERS T ALL STONE IS ELEV.=73.8_ 6" OF FINISHED GRADE THE COVER TO WITHIN THREADEDCAP DOUBLE WASHED 6" OF FINISHED GRADE 4"0 Pvc WITH N 3" ELEV.= 713_72.9 4 CAST IRON OR CONCRETE COVERS OBS. PORT OF aRAnF SCHEDULE 40 P.V.C. " DIA. SCHEDULE 40 PERFORATED PLASTIC PIPE 4" CAST IRON OR END CAPS ON ALL PIPES SCHEDULE 40 P.V.C. „ DIST.=38.9= 4" CAST IRON OR S P 5' ON C 12 in. p 3" LAYER OF SLP.=0_02_ SUMP S LP.=O-005 SCHEDULE 40 P.V.C. CONCRETE COVER � v1_ 0808080�080 FLOW LINE INVERTDIST: 4_6 $LP.=�_02_ INVERT DIST.= 12.1_ WASHED STONE ELEV.—70.92 70 14 "o"o"o" "o"o"o"o"o"o"o"o"o"o"0"0"0"0 0"0"0"0"0"0"0"0"0"0"0" ELEV=--_- 14" ELEV. 69_57 000-0-0 0-00000°0°0°0°0000o0o0o000o0o0o0o0o0o0o0o0 00000000000000000o0o0 Iop i�L 'INVERT SHALL BE FIELD VERIFIED THE �ENGTH of ELEV. 69.89 _69 80 v < 6" LAYER OF OUTLET TEE is ELEV.-____ —" ELEV.= 69_63 c a/6•TO 5 6' HOLES AT THE 6 O'C CK OS N 0 O O -/4" o v J � u u "� c, o o c> o 0 0 o c PRIOR TO THE INS:TALLA71'ON OF .DETERMINED BY THE LENGTH OF O O O O O O O O O O O O � O O O O O O O O ASHED STONE ANY SEPTIC SYSTEM COMPONENTS UgUID DEPTH OF LIQUID OUTLET TEE DISTRIBUTION BOX, '�.;0 b O O O O 0 O OoOoO0o -) 000 0:,,0 O 0,�0,�0� E _ THE TANK USED. DEPTH BELOW FLOW LINE Llm=68_9 (SEE CHART AT RIGHT) 4 FEET . 14 INCHES IF MORE THAN 4' .OF COVER. A 5 FEET 19 INCHES H-20 1500 GALLON SEPTIC TANK SEE 310 CMR TO BE WET ARING STRIPOUT ALL UNSUITABLE MATERIAL 6 FEET ..... 24 INCHES USE H-20 .L0 TESTED IF TO BE PLACED ON rs.22� (s) MORE THAN ONE OUTLET. AND REPLACE WITH MATERIAL THAT 9.4 6" OF STONE OR TO BE PLACED ON l COMPLIES WITH TITLE 5 STANDARDS 1 MECHANICALLY COMPACTED . SOIL 6" OF STONE OR — ' MECHANICALLY COMPACTED SOIL. - - - - - - - - - - - - - B- - - - - - - - _ - - - — MECH BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV = 59.5 USE A TANK WITH THREE COVERS: - USE H-20 LOADING. SOIL TEST DONE BY: J.E. LANDERS-CAULEY P.E. IF MORE THAN 4'. OF COVER. WITNESSED BY: DON DESMARA3_____________ ----- PERCOLATION RATE: 5 MIN INCH P# 15569 TEST HOLE 1 & 3 DATE: 0129/_L ELEV. PROFILE OF4 '�';�, DEPTH HORIZON TEXTURE: COLOR MOTT. OTHER 00 . SEWAGE -DISPOSAL SYSTEM: 3 PERFORATED PIPES .NOT TO SCALE o"-8" O/A SANDY LOAM 10YR 3/3 — SECTION A. A CERTIFY THAT I AM CURRENTLY APPROVED BY THE f DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT TO 310 CMR 15.017 TO CONDUCT SOIL EVALUATIONS 8"-26" B SANDY LOAM 10YR 5/6 AND THAT THE ANALYSIS GIVEN HAS BEEN PERFORMED GENERAL NOTES: BY ME CONSISTENT, WITH THE REQUIRED TRAINING,. EXPERTISE, AND EXPERIENCE DESCRIBED.IN 310 CMR 15.011. 1 FURTHER :CERTIFY THAT THE RESULTS OF 1. THIS PLAN IS FOR THE REPAIR OF AN EXISTING SEWAGE DISPOSAL SYSTEM. 26'-66" . ci SILT LOAM 5Y 7/4 srRi our ;as MY SOIL EVALUATION, AS INDICATED ON THE ATTACHED 2. PLAN REFERENCE LC 36349 A LOT 30 BARNSTABLE REG. OF DEEDS. NEC SSARYSOIL ORMRA1R5 A o TAATE AND D1 0 3. THIS PLAN IS FOR THE INSTALLATION ./REPAIR OF SEPTIC SYSTEMACCORDANCE WITH, 3.10 4 AND NOT TO BE USED FOR SURVEYING. AND ZONING PURPOSES. 66"-150" C2 M-F SAND 2.5Y 6/6 DESIGN DATA: 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. NO H2o TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS ENC'D FOR THE SUBSURFACE DISPOSAL OF SEWAGE. NUMBER OF BEDROOMS _3_(T FE)_(MSTING) 5. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN TEST HOLE. 2 & 4 DATE:03 22/_U_ ELEV.__ZSO___ 6" OF THE FINISHED GRADE. DEPTH HORIZON : TEXTURE COLOR MOTT. OTHER GARBAGE DISPOSAL _NS2Nl'a_(0,l__--_ 6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE TOTAL ESTIMATED FLOW ,34____ GPD SAME, UNLESS NOTED BY FINAL CONTOURS. - * `' r ( 110--_ GAL/BR./DAY X ___ BR. ) 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE 0"-4" o/A SANDY LOAM 10YR 3/3 9F �s OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR REQUIRED 31► �� ; SEPTIC TANK CAPACITY 150(LG9,I+(_ ) WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 OF DRIVES OR PARKING 1500 GAL. PROVIDED L/w� :�s �uLfY GAL.(PROVIDED) AREAS UNLESS NOTED, 4"=30" B SANDY LOAM 1oYR 5/s z LEACHING AREA REQUIREMENTS < c� \f63.: r i 8. ANY MASONARY UNITS USED TO BRING. COVERS TO GRADE SHALL ` N .351,31 BE MORTARED IN PLACE. SIDEWALL AREA _0__-- F. S ® 'p 9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH 30"-64" Cl M—C SAND 2.5Y 6/6 BOTTOM AREA -441L_ S.F. DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. LEACHING CAP.(BOT. & SIDEWALL)_333.00 Gam,• 10. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF s4"-120" Cz M—F SAND 2:5Y 6/4 ALL UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. NO H20 RESERVE LEACHING CAPACITY _333_00 _ GAL 11. UNTIL APPROVAL FROM THE BOARD OF HEALTH IS GRANTED, THIS ENc'D PLAN IS SUBJECT TO CHANGE. APPLICANT: KATHLEEN S. NASTASIA, TR. DATE: 03/30/18 NOTE: THE TOWN OF BARNSTABLE REQUIRES THE ENGINEER TO INSPECT ALL SEPTIC SYSTEM COMPONENTS INCLUDING INVERTS, AFTER THEY HAVE BEEN INSTALLED AND BEFORE THEY ARE BACKFILLED, SHEET 2 OF 2 JOB # 2913 2E—NERAL N0 TES• 1 HOUSE NUMBER: 69 2.. . .ASSESSOR'S INFORMATION: MAP 251, PARCEL 30: 3 FLOOD ZONE.- X PANEL N0. 250001, 0562 J. (7/1612014) 4.r ZONING DISTRICT RD-1. o 5 OVERLAY r DISTRICTS- GROUNDWATER PROTECTION 'DISTRICT &..RESOURCE PROTECTION DISTRICT 6. LOT COVERAGE BY A. EX/S11NG STRUCTURES'. 1;995 S F./ 15,764 $F = :12,79 10' B.: PROPOSED STRUCTURES• 2421 S F.% 15;764 S F _ 15.49a . . 3 7.. TOPOGRAPHIC.INFORMATION COMPILED FROM.AN ON :THE GROUND INSTRUMENT SURVEY .n N N 8.. ELEVATIONS SHOWN ARE BASED. ON NORTH AMERICAN VER 11CAL DATUM 1988 I P"CA'L 46 NEw'vEWAY N/FI I�AT�ID B. & LINl�.4 .4 Z , LDi��'�IAN LEGEND 20" --- -72 - _---- `. EX/STING 2' CONTOUR . . TREE -- 70 — — EX/STING 10' CONTOUR +732 . +7 2.5 EXIST/NG SPOT.ELEVA770N PP U77L/TY POLE . _ c8/DH o CONCRETE BOUND FOUND . .5 FOUND O IRON P/PE PARCEL 45 BA NIP 5/TE PLAN FOR KA THL EEN S. NA S TA SIA, TR. #69 CONNERS ROAD CEN TER VILLE, MA Sccr/e. "=20 Date DECEMBER 12, 2017 OFOF Ssq �t ��� a a .. • o� cs r ,u2ck �c Assoczates Inc. � /1r D o GAR Y S.LABRIJ= 5 �J J (i OZIi�JTit Road,,,a D D NO.4 . 3 to ay y GLGL L7o.�i v0� io l isl� ®� Nortfz .FWmoutA Muss 02556 ---' (508) 563 7777 e e PARCEL Z9 NIA' JUL ff .4. BRIANl> C +69.1 \O IP \ FOUND C /DH \ UND ( S55'09'43"E l , ' \-PP 181.90' 73.0 + O 570-5 \ 72.0 69.4 O - - 73 Z ` D '18" PARCEL 30 72.3 } Z METER Q TEMP. 18 PINE 1V' /84.1� Y.F. GAS 73.4 1 ELECT. I PINE 73.4 . 14" 1 ' , p SERVICE 1.8��0.0. *6.7' TREE Liol /V r REBUILD 6 .8 t 8 I RES RVE/AREA I RE-BUIL TARE EXISTING 1 V TRE ?I2 I o DAMAGED / DECK I I 73.1 HOLLY FOF.S 753 / I �$ $ BUSHESif A-a I IS j 73.6 o _ NEW % PwE o 3.8� 6 ,��O' GARAGE NEW I 1 69.9 / 5+ '� 73.9 - --- - 6 _ 38 9, ------- ----- - - - ` 7o.s 30 00 ,000 r -- ;' - 25' _ I LLQIL,,: ------ _ 3 l 72.4 1 PAVED DRIVEWAY +7t3.6 3 F.P. �- �EDGE� OF PAVEMENT 70.2 N -------- ------ -------- 20' 5 71.2 / t t° 73.7 73.5 TREE O 12 / DOUBLE - - - - - . 0 Pl +73.2 HOLLY. OLD :M -CESSPOOL' - / 164.00' . EDGE OF PAVEMENT 70.9 CENTER DRIVE WA Y (20- WIDE) LANE - � 73.5 . 72 88 POST RAIL FENCE 73.5 BENCHMARK: CB/DH NAIL & CAP FOUND EL. 72.03 PAR CAL 3> N/F HAR IXT 1. STMUBT BA 0 D _ NOTES: THE. EXACT LOCATION OF THE WATER SERVICE IS UNKNOWN. IF IT IS WITHIN 10' OF ANY SEPTIC SYSTEM COMPONENT, IT SHALL BE ENCASED OR RELOCATED. THE EXISTING D-BOX AND PITS SHALL BE ABANDONED, PUMPED, REMOVED AND DISPOSED OF AT A SUITABLE LANDFILL. M., R.J W. DA7E.• 091251-Y7 REV 0.3130118 20 0 10 20 40 GSY SilEET 1 OF? SCALE.• 1 /NCH = 20 FEET bcts 2004 jSS17063 jdwg�SS1706J3F dwg i f Yn� _ GENERAL NOTES: 1. HOUSE NUMBER.- 69 . 2 ASSESSOR'S INFORMAAON• MAP 251, PARCEL 3O PARCEL 29 ,1 ROOD ZONE.- X(PANEL NO 25001 C0562J) N ✓ULfr A.A. BRL!/VD 4 ZONING DISTRICT- RD-1 fS I r A RESOURCE aV DISTRICT � S OVERLAY DISTRICTS. GROUNDWATER PROIECRON 0 IRC RfSOUR PR07ECn D/S1R 6. LOT COVERAGE BY.• IP, A. EVS17N0 STRUCTURES 1.995 SF./14764 SF. = 127X ND ITU �D1i B. PROPOSED STRUCTURES Z421 SF./14764 S.F. 114X PWND I 'E 181.90 PIP 4 �, E BA . 7s.o 7. TOPOptAPHfC lNFQRMAAON COMPILED FROM AN ON 7Nf GROUND SURVEY I O' 570-5 / 0 73o Q ELEVAAQNS SHOW ARE SED ON NORTH AM CAN VERTICAL DATUM 1988 69.4. _ /1B- 72.3 PINE GAS - 73.4 PINE -- : 73.4 - METER _ 1 / m ,� 1p�I.e/PARCE'L30 . Z�7 TFM dV 15,!B4f S E r 73.1 (7) ARCS a OL ES 3.6 A£N P ,,T L LEGEND -. I 4<s *0 1 c4�c a4rttTlr4r DAf?D B. & NlL! A. 69.9 .. 1 /. W 000 E �. : 73.6 NEW 1. _- .. . - I - - .- GALLON - 739 - LOVE•E..w --. —7z.---- EXISTING 2'CONTOUR 70.s - - o. D-80% ;73.6 ?3 --70-- EXISTING10'CONTOUR - - - -- -- __� r_ _ 7z.a � - - +72:5 EXISTING SPOT ELEVATION PAVED DRIVEWAY rt 7�5.6 F.P. PP � UTILITY POLE PAVEMENT- 20' .5 70.2 o 71.2 / --- - - --- 73.7 73.5 TREE CB/DN p CONCRETE BOUND P 2• - NOLL.� %! TREE - ND - R FW - -- +73.2 CESSPOOL - - - FW ND 0. IRON PIPE mry - 184.00' - _ t 73.2 - - _ EDGE ut PAVEMENT CENTER 70.9: R Aww wr (z0•WIDE) 735--. LANE 73.5 l NAIL aMa s° .. EL 72.03 .. .. . . SITE PLAN P 1 FOR X ARM 9 PARC= 45 sOT S/A, TR. O XARRiE•T STE'/ART B,4RB�dR4 F.~ f1v�E��n: TR KA THLEEN S. NA D �. #69 CONNERS ROAD CENTERV/ILLE, MA Scale: 1"=20' Date: DECEMBER 12, 2017 Xarwick Associates Inc. ORAwW en cIc RsW DATE 091251t7 zo o ,a IV4V 69 County Road BOX 801 North Falsnout/4 Oass 042556 CNeaYm BC sAgz*r 1 OW ! SCALE J AVOV-M TFFT (506) 569 — 7777 ti ORAINNG ARMS SS1706".DMG I i i I < I b GENERAL NO TES 1. HOUSE NUMBER. 69 2ASSESSOR'S INFORMA 770N.• MAP 251, PARCEL 30 P L'!�'L .29 3. FLOOD ZONE X PANEL NO. 250001 NOT 0562 J (7116/2014) AIL Ir A RR". 4. ZONING DISTRICT RD-1 t 5. OVERLAY DIS77?ICTS• GROUNDWATER PROTECTION DISTRICT & RESOURCE PROTECTION D/STRICT 69.1 6. LOT COVERAGE BY- 0 F FOUND / A. EXIS77NG STRUCTURES. 1,995 S.F./ 15,764 S.F. = 12.7X i CS No ', ss5ros'43•E B, PROPOSED STRUCTURES.- 2,421 S F./ 15,764 S F. 15.4X 0 t ,_P 1$1.90' 73.0 7. TOPOGRAPHIC INFORMA77ON COMPILED FROM AN ON THE GROUND SURVEY 570-5 +,72.0 + O s�.4 Q , ' 73.0 8. ELEVA770NS SHOWN ARE ARE BASED ON NORTH AMERICAN VERTICAL DATUM 1986 , -- Z €� '�� '�18" 72.3 p Os PINE X PINE GAS 73.4 73.4 METER rn 0 o TREE 18" TEM ' PARC�'L p0 3 l C TREE� ELE f4,784.Z_ S F. �6 s SERVI E IE-BU/LTRAL N i 73.1 #a/s A9 M o, i F.F. 1-5. ' HOLLY PARML 46 `.�.� w +, � B SH S 73.6 NE/Y N£/Y- cr if *PINE t` 'j3.8' GAR.4 GYPPt+flY.4Y LEGEND sy. NEW 1,000 l -,GALLON 7 .9 EXISTING 2' CONTOUR l 70.5 ; 0 A__L=P_� D BOX: 25 _ 73.8 _____ - EXISTING 10' CONTOUR 72.4 _ - 'PAVED DR! a +72.5 EXISTING SPOT ELEVATION F.P. 70.2 PAVEMENT PP `ia' U77UTY POLE 71.2. 73.5 TREE 73.7 p t7"5 FOUND CONCRETE BOUND PINE J y� +73.E HOLLY OLD CESSPOOL T TREE IP id FOUND 0 IRON PIPE 164.OD' +73.z E PAVEMENT 70.9 �,.r` CENTER '' ' c20' WIDE, LANE 73.5 ;' 72.s PST & RA L FENC 73.5 � GCB H AIL & CAP FOUND EL. 72.03 Sl TE PLAN P"C1�'.L 3f P"M 45 - FOR 0 11ti N D 'T it. STL'Y"T BARBUM F. SMINMO, TR. KA THL EEN S. NA S TA SI A, TR. #69 CONNERS ROAD - CEN TER V/ILLE, MA Scale: 1 '"=20* Date: DECEMBER 12, 2017 ARY S,LABRIF Xa7wick dPc Associates Inca NO.4CO333 v, DRAW 0) I.M, &ASK DATE 09125117 20 0 10 20 46 � 68 County Road Box 80f av er cs�c _ _. ,. .North FalmmdI4 Bass OR6'56 SCALE.• 1 /NG95� = 20 FEET .�; (508) 56.E -- 7777 Vwd stets 2004 jSW7 jdbV jZ170&JV 13 3 2,3