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HomeMy WebLinkAbout0292 FULLER ROAD I II I i bu r v Town of-Barnstable - 4114 ,, p 200 Main Street,Hyannis MA 02601 .508-862-4038 Application for Building.Permit s a Application No: B-17-203 Date Recieved: 1/25/2017 Job Location: 292 FULLER ROAD,CENTERVILLE Permit For: Building-Siding/Windows/Roof/Doors Contractor's Name: JAMES P CURLEY State Lic. No: CSSL-099138 Address: Centerville, MA 02632 applicant Phone: (508) 790-4508 (Home)Owner's Name: BULLERJAHN,ERIK O&CAROLINE H Phone: (617)840-7650 (Home)Owner's Address: 221 COUNTRY DRIVE', WESTON,MA 02493 Work Description: Strip and re-roof approximately 5 square of asphalt architectural style shingles. PP Total Value Of Work To Be Performed: $2,600.00 V cm •Z. P.. Structure Size: 0.00 0.00 0.w-i .Width _ _ Depth. Tofal Area I hereby swear and attest that I will require proof of workers'compensation insurance for every:contractor,subcontractor;or other worker before . he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his.intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute;regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. _. All permits approved are subject to,inspections performed by a representative of this office.. Requests for inspections must be made at least 24' hours in advance. Signed: James Curley 1/25/2017 (508)790-4508 Applicant Date a Telephone No. Estimated Construction Costs?Permit Fees Total Project Cost : $2,500.00 Date Paid Amount Paid Check#or CC##Pay Type Total Permit Fee: : $35.00 1/25/2017 : $35.00 xxxx-xxxx-Xxxx-= Credit Card ........ 5483-.' Total Permit Fee Paid:" $35.00 i Engineering Dept. (3rd floor) Map ( Parcel C4Q —3" Permit#= J • 9 I - House# 2—�Z-- �� Date Issued �- 9- 98 Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) - F Conservation Office(4th floor)(8:30-9:30/1:00-2:00) - `�. 1�k� t®kt '�® � Planning Dept.(1st floor/School Admin. Bldg.) �® ��7f Definitive Plan Ap ro Planning Board Gj ` 192 C" LE. 12 J � .c C� 0 ° TO �OF,BARNSTAB ��� Building Permit Application Project Street Address Z q Z Ev�-c4— e4 , ' 4 Village � �/�Gty✓i ` Owner STD I�.� eiV(,dN Address ; �`( 'I�l/fiG(/.1't k1vl�� 44, 'a4tSTG�,S Telephone r0 4 w_ b nr1 0 t�'f/� Permit Request N Gu/ 1��Vti►<, s .First Floor square feet Second Floor q 72 square feet Construction Type 01 o dV) FK.4V .{_ of Estimated Project Cost $ M, ?2sp. Zoning District Flood Plain Water Protection Lot Size +r7 0 W.V,, Grandfathered dYes ❑,No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes OkNo On Old King's Highway ❑Yes ,VNo Basement Type: & Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 1'1 Oki-C, Basement Unfinished Area(sq.ft) �- Number of Baths: Full:- Existing New `Z— Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count 3 Heat Type and Fuel: 6�Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes E rNNo Fireplaces: Existing New 1 Existing wood/coal stove ❑Yes XNo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) Attached(size) 22,,E 2 _q ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeal7No orization ❑ Appeal# Recorded❑ Commercial ❑Yes If ,es site plan review# Y Current Use Proposed Use ICI cw A—f8 0 e4.1 � Builder Information Name Cr (a cu Telephone Number (VU Y,L-(ZZA— U g'6 9 Address 2( ( �I f i2 )ut,h� License# 0H 3 1/Y1,G9/&rdKA vK a-, DjtS C Home Improvement Contractor# 02( If(� Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,.AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENI FOR THE FOLLOWING REASON(S) n, X 7i � 7—a2 0 9P I r, FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE{ OWNER DATE OF INSPECTION- _ FOUNDATION FRAME - "-'` ,s �". .1��' K�'� � • ' . , E i- r r • INSULATION - FIREPLACE? ELECTRICAL•? ROUGH FINAL PLUMBING: 77,ROUGH FINAL OAS:' t,'`� '_ROUGH ' FINAL : { , FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. R :f r o FULLEA 76oA 51"E S 11y,77 �i 2A �a m � Q m� m m 0 7- 01g1S FOUWA F 7 t 3 n N � �o zu LOT 3 10 30, 439 SF. v � co � v N 2 102.00 . N 64'21 '57"W "TO THE BEST OF MY KNOWLEDGE, THE PLOT PLAN OF LAND FOUNDATION SHOWN ON THIS PLAN IS AS L OCA TED IN IT ACTUALLY EXISTS AND CONFORMS; TO CEN TER VIL L E - MASS. THE ZONING REGULATIONS �/V OF BARNSTABLE, REGARDING '. " PREPARED FOR DATE.'APR. 15, 1998 /�J dQ��U GP1 (4 CHAHLES CEN TPA L CONS TPUC TION SAi•JiCKI L DATE.,APR. 15. 1998 SCALE: 1 "=40 FT. CAPE 6 ISLANDS ENGINEERING FLOOD ZONE NON-HAZARD D-61 3BC - MA SHPEE — MA SS. rKUJr U 1 1 1 1 l-r Iz 1 2424 1 24 L`1 L416 Zyr . I6KrL) ' 3�[yc QIC W000 c�boL�_--_ Q —! Y N 2Y2Y 2Y2S TL - 9 6 r PREPARED FOR • 24L 24I� �.� 4 241 .. .. .. — 44, ��Fy1un 1'4t1g� S— _� C L=-- --S�°«- �' Central Construction Company;Inc r Sleve Devlin•President arr'1 6 � � 27 Clover lone Morslons Mills,MA 02648 508-A20-1340 C-Dcabti \l 1 F�.,cd_apor.. `11�zA� I N SCALEI�s = I N 0 1 3 DATE DWG NO. 2J2 , iOL4 Zal =1 bESIGN �•OcvL HECK .. WN — .� OB O. S r �q 1"KUJC L,I I I I Lr- j— - i - _ "C;vc S-I R r•,-I J Al lira. sF�ru-;r1�,5 Zxb Co Ill o.cr6s 3z"o.0 I� 2-.(o ,ncc. _ t "a 1� c —_LOOP -G-R.iZS .I.[,�'. c•_i1c� c Z (SaF- II 2.36 iilsvtz�rclU •c •''jl I0 -Ye�J— ` -T`1-rG+�_l�frJSc iA1t� 2x4 Sr1pS 16 r U•L 2�33 Li I J T- F- k so tG^ I( —- - PREPARED FOR X HGa�Dt/v /� i T ff N `ICY_fir .Po,r z Pj- f 210B&,I_ Central Construction Company,Inc. I a .I Ts (6' u�L _--- _ �I sCIZ i'T•Suur IG"o•c — � Slav Devlin•President 3 Z(IZ GLT r y I li 1,'UN 1 S oh1[ TvV— 21 Clover lone Marstons Mills,MA 02648 508d20L1340 3"z L SCALE "..I_ST4cL LHi1 O DATE DWG NO. ^g c I; bESIGN a ,,VL-!- :iJOHECK ` �. AWN — :�� pg, 0 :I L — _ rnVJGVI IIILG ✓ti I,_.0 — (r Ali Cj :7 'M - - -� T2 -- L L� _.� ._..f --- --- 1 — ------- ;•� -- — - -- _i PREPARED FOR - - -- ------- -- - -r ? -24 E+ 14D_— �. i -S-Zn G.,,r P �entral Construction Company,Inc, Slav Dmlin•Pres del 4' IL 27 Clover LoneIMorstons Mills,MA02648 5OB420 1340 SCALE 101 j, DATE DWG NO. DESIGN �1 PHECK r AWN -- OFt 7. ;4 L� _ - rnv�c�r IIILG La 16' � PREPARED FOR - _ — Central Construction Company,'Inc, Store Dmlin•h6dmf 27 Clover lane e Ma stops Mills,MA 02648 5OBd241340 — SCALE IFDATE DWG NO. - — ----- - — bESIGN O Ll HECK . � C \ F I ) AWN -- — Ob> 0. S OF z - _ B L(�v P-*0 9 1 -----=-- -- - - -- — — --_1_ PREPARED FOR _T �4' ICI \ I ' Central Construction Company,Inc. _ Steve Devlin•President 41to I I Syr I 27 Clover Lane•Mors ons Mills,MA 02648.508d241340 SCALE I = I �i 0 tz lot ) DATE DWG NO. DESIGN , I, IjGHECK i DRAWN — �s h OF " OB, O. S" rnvdcs,r r r i Lc rJLI{n✓ h_ i = r FE 16 PREPARED FOR Central Construction Company,Inc, =fiI Steve Dwlin•President 21 Clover Lane•Marston Mills,MA 02648.5OU20-1340 — - _ -- -- -- - _ SCALE LIM ._ .. I •. _ _.—.-- —_.. .r DATE DWG NO. --_ - — DESIGN Lk, HECK AWN ---`— _�WMET OF N rr<v�c�I I I I Lr- ;�- __ 'ZI 24Pi 2'Iz4 ___.---- If 14 zy z416 bo Cr I I:f 3Cu cR --Wouo 11 2-T2-T t I N I N i 1 2r7-T 2rzF TG 9 PREPARED FOR �-^1.J ATTj L u�}snr�(-4Lnn) y_ Central Construction Company;Inch a- Stem Dmlin•Pr6dent am c « � 17 Clover Lane•Marstons Mills,MA 0264E 508-4201340 Zc.laOon \IIt7�� \� I r SCALEIJg = I1 T N O 0I yl �c k DATE DWG NO. z•z I zozv ^= 1 ` DESIGN C•O[VL a� HECK �. DRAWN — OB OF tKUJr LI IIILr r ION z>L6 Co 1l k res 3z"o.c 5 I 2-l0 ,b4'r— _ r r: _ G-ft yz; .,ac,\ = 33LfSalt'— VSCU.S IAJIU00-J Gr.Ch= 2.7q$6 t\oj Y- l 2,74 �I u - 2v.4 S7�GS 16 U L 2.)33 L1 `YI✓arc, u•al�s_".._. it I' CL7 c,Cti'}1:� 3 � t It PREPARED FOR vex Nora �Y_Pr 194 ,6 PT Sour IG"O.L — bK 2 clo gv� Central Construction Company,Inc, . Steve Devlin-President 3 2,L b_ pZ_.S,��4 f�;,:} Scu I / li' u��,S v>uv'c TvtG 27 Clover Lane�Marstons MiIIs,MA 02648�50Bd2P1 340 S7c c LH1 SCALE 0 DATE DWG NO. IDESIGN H CK y .. AWN q. STEVEN eJ. PIZZUTI ATTORNEY AT LAW 336 SOUTH STREET HYANNIS, MASSACHUSETTS, 02601 TELEPHONE(508)771.1911 • FACSIMILE(508)790-0072 February 9, 1998 Town of Barnstable Building Department, South Street Hyannis, MA 02601 ATTN: Ralph Crossen, Building Inspector RE: 292 Fuller Road, Centerville Assessor's Map 189 Parcel 90-3 (Lot 3) Assessed Owner: Sally A. Mahoney Dear Mr. Crossen: Per the request of the prospective purchaser of the above-referenced parcel,I have conducted a title rundown so as to determine when the lots were last held in common ownership. The records reveal that Mary Carroll Smith and John F. Smith,Jr. deeded Lots 2 and 3 to Stephen W.Mahoney and Sally A. Mahoney by deed dated September 20, 1984 and recorded October 5, 1984 in Book 4276 Page 95 (copy enclosed). Locus is shown as Lot 3 on subdivision plan dated September 14, 1984 recorded October 4, 1984 as Plan Book 388 Page 35 (copy enclosed). Stephen W. Mahoney and Sally A. Mahoney conveyed Lot 3 to Sally A. Mahoney, individually, by deed dated January 6, 1986 and recorded January 15, 1986 in Book 4276 Page 95(copy enclosed). Both parties deeded Lot 2 to Stephen W.Mahoney,individually,by deed dated January 6, 1986 and recorded January 15, 1986 in Book 4884 Page 352 (copy enclosed). The locus was conveyed into separate ownership prior to the zoning change. Should you need further information,please contact me. V t ly r . 1 1 SJP/dd I6 PM'@'I Ocr 4 2 rr � N v LODIS SKETCH SCALE 1=2000' ZONE RD-I MINIMUM WIDTH=125 FT. MINIMUM AREA-20,000SQ.Fr.. MAP 189 PARCEL 90 ��WIOE CRB 1941 Lo S64°25'10".W =7T CRB 576°56'51'E 45.04 0 A f�O 5B •- :� %01. E 2p, w ,58. ° 8 0 CPe-584 g2 94 K LINE, �(.� 2�9 i,;� °p 6�6pC 12 23 iz: Few V0 i ^ 9 02 9PCK p/0 - TOWN OFBARNSTABLE COUNTY WAY oc �e m 5Et �5 3 PL.BK.230 PG.113 ;// n 30,439 SO.FT. O 3 l �3 2 25,893 SQ.FT.. t^ 0 30,730 SQ.FT. j N N O m IVAR A. 1JHNSON PL.BK.291 PG.55 _^ 26.14. 102.00 p Z �.. `64°27'S7'"Vi—I`28-1'q N 64°09'13"W QD 20.44 o � N65°20'26"W ® 1= 40.63 rn N57°58'21"W 73.954713 21.38 N72°IB'36"W N71°30'51W �yo.4a' a10.5� a3t.�3g IVAR A. JOHNSON - PL.BK.291 PG.55 PLAN OF LAND IN BARNSTABLE,(CENTERVILLE) MASS. FOR I CERTIFY THAT THIS PLAN CONFORMS MARY CARROLL SMITH .WITH THE RULES AND REGULATIONS OF - THE REGISTER OF DEEDS. SEPTEMBER 14,1984 40 20 0 40 - SEPT.14,1964 f 76 6 SCALE IN FEET 1"=40' REG.LAND SURVEYOR - EDW'ARD E. KELLEY , REG. LAND SURVEYOR - CUMMAQUID,MASS. . APPROVAL UNDER THE SUBDIVISION - - CONTROL LAW NOT REQUIRED. - L DATE BARNSTABLE PLANNING BOARD i I . 9UOK427�j },r� Q95 MAe6ACMUa11.aUITCLAIM O[IO eNOnT FOAM (INOIVIOUAL) wet V l JJ 48832 y� MARY_CARROLL SMITH_and JOIN_F "SMITH, JR. as joint tenants, both „ "of 262 Fuller Road, Barnstable (Centerville) , Barns tableounry,MassachUSCrts, into and >SJfY3f � for consideration paid, and in full consideration of Security ,. THIRTY-ONE THOUSAND FIVE HUNDRED ($3.1,500.00) DOLLARS CESTER 9=13'0 STEPHEN W. MAHONEY and`SALLY_A"MAHONEY; husband and � 'ropertY wife as tenants by the entirety, both hueetta. of 316 Chews Landing Road, Haddonfield, NJ 0.8033 with qutttlatm CIMItnuttts h er and Y i;'the land in Barnstable (Centerville) , Barnstable,'County, Massachusetts, p on the southerly side. of Fuller Road and more particularly being described as follows: (Description and cacumbrances,;f any) ` f on the ) cry six .. LOTS 2 and 3 as. shown' on a plan entitled "Plan of Land in Barnstable, (Centerville) Mass. for ary Carroll'Smith, September 14, 1984, Scale iously 3o:Ird in Feet 1" 40',. Edward E.- Kelley, :leg. Land Surveyor, Ctutttttaquid,u zed on Mass.", recorded, in Plan Book 388, Page 35. For our title see deed recorded at the Barnstable County Registry, j a Do t ` of Deeds in Book 3037, Page 143. - iowef t r _ harge3 ection by the rower r.. 'uc:ng hick i shall ecure i t uire I f any on of jpihtr>!s our..l d9 and sellis tbia....20th, day of ...September . 19 84 t ) L1 �./ Seall : ........ ... .. ........ ...... .. Seal) { #14t lomtttattmraltlt of ffiassar4ot rtts 584 Barnstable, IL Sep er 20, 19 84 x s : Then personally appeared the above named. Mary Carroll Smit and John.F. Smith, Jr. and acknowledged the foregoing'insrrument to be their free d fore me ; f ...� .... _.... i Notary Pubtic�_93GW7UEXOCXIIRX ' I � I August 8 1986 M7 commissionerapi Q ," = i ("Individual—Joint Tenants—Tenants in Cottunon—Tenn by the Entirety.) ; 1 � CHAPTER. 183 SEC 6 AS AMENDED BY CHAPTER 497 OF 1969 Even deed presented for Heard shall contain or have endoned upon it the full name.residence and post office address of the grantee j +red a recital of the amount of:he full consideration thereof in dollars or the nature of the other consideration therefor,if am delivered for a specific rnt"Ictar7 rum.The full n+roldenuon shall mean the total price for the conveyance without deductiaO fir era► liew of tvmh m. ftann. assumed br the Stantee or remaining then mn ml. All such mdorsem and realists shall be recorded as of the deed, Failure to campy with this Mown shall not alfect the validity of and deed.No register of deeds ahall saw"a deed for ncarWP4 Maim . it is in compliaact with the requirements of this section. fli.vu4%L1Lj OCT 5 84 l 0 _ NAq"CNV/ 7'6T8 QUrrC%AIN DaaD 9noore►o"tl (INDIVIDUAL) $HI t 6�-4g85:sF Q01 02311 STEPHEN W. MAHONEY and SALLY A. MAHONEY, husband and wife ;`- s tenants by the entirety, .both VTFGI27IA ' K• 0rl 813 Arcturus on the Potomic, Alexandria County, " fi 32irF?S74?hiiAlfe?fd,for consideration paid,and in frill.tbavdmtion of„,,O"/0-� grantsto SALLY A. MAHONEY tt3 j Of 813 Arcturus on the Potomic, Alexandria, VA with gttttriztm taarttaub d" the land is Barnstable (Centerville), Barnstable County, Massachusetts, on the southerly side of Fuller Road and more particularly being described. as follows: lDc"ptiw ad eacumbt+Dm,if any]. LOT 3 as shown on a plan entitled "Plan of Land in Barnstable, t (Centerville), Mass. for Mary Carroll Smith, September 14, 1984, i Scale in Feet 1" = 40', Edward E. Kelley, Reg. Land Surveyor, Cummaquid, Mass.", recorded in Plan Book 388, Page 35. r For our title see deed recorded at Barnstable County Registry of Deeds in Book 4276, Page 95. z t I i { 311tturae our hand s and sal s this !!! da of 194 . Stephen W. Mahoney g 2 ' WS 11 �: Mahone�� Sf{r 1Zammnttmral14 of ! r4uAc1La I Barnstable, SL 19 Tben personally appeared the above named Stephen W.�aho7-- and lly A. Mahoney aclmowledged the foregoing instrument to be their__free- aW d before me %!Noaq Public-3jrwtGr7�(SC7[S�1oC ' v I Mr ammit,im erpires g ('ladividual—joint Tenants—Tenants 7n Common.) aiAVM 183 SEC 6 AS A.�'DED BY CHAPM 497 OP 1969 - I Eva1 dad preened for record shill contain or ban eodorsed upon it the full name.residence sod post office addeess of the pweee 1 and a ee:ctta!of the amount of the full considetsaion tbered in down or the nature of the otbcr mntideraton thertfor,if Dot delivered for a speaLc mooeuq� The full moridersuon%bail morn the total prig m foc the avevaoce without deduction for my liana or arvinhnnaa auumed b/the grate,or remauum thereon.All such endorsements and rratalr sball be recoedid as pan of the deed. } Pail=to comply with this teetioD shall r7tr affect the validity of ter deed.No register of deeds shall accept a deed for raordma min k b in comptiaoa with the Wq--;r=W at" Jail 15 86 { s DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Nuiber: Expires: _ Restricted To: 00 ' STEPHEN J DEVLIN 210 OLD MILL RD i MARSTONS MILLS, MA 02648 F l HOME IMPROVEMENT CONTRACTOR { Registration 108752 .'° Type - PRIVATE CORPORATION I, Expiration 061241§6 CENTRAL CONSTRUCTION INC. Stephen J. Devlin 690i, 1d Mill Rd. ADMINISTRATOR Marstons Mills MA 02648 f * i Restricted To: 00 't . i 00 - None + 1A - Masonry only 1G - 1 S 2 Fasily Hoies ! 1 9 �.-� - r I 4 I I. License or registration valid for individual use only before expiration date. If found j return to: One Ashburton Place Rm 1301 j Boston Ma.02108 I jI 1 f • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please pri t. DATE •3 0A r JOB LOCATION Z_q Z0 N.ks/v Number Street address Section of town "HOMEOWNER" �W qz-o- 076"1 `-n( - -OS-1_6 . Name Home phone Work phone PRESENT MAILING ADDRESS 2 ' �� thaw City/town State Zip cod The current exemption for "homeowners" was extended to include owner-ccc;:v dwellings of six units or less and to allow such homeowners to engage an i. dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person (sj who owns a parcel of land on which he/she resides or intends to side, on which there is, or is intended to be, a one or two family dwellih: attached or detached structures accessory to such use and/or farm structurE* A person who constructs more than one home in a two-year period shall not considered a homeowner. Such "homeowner" shall submit to the Building Of== on a form acceptable to the Building Official, that he/she shall be resmonz for all such work performed under the building permit. (Section 109.1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Building Code and other applicable codes, by-laws, rules and regulations. The undPrS_g;1ed "homeowner" certifies that he/she understands the Town of Barnstable Building 'Departament minimum inspection procedures and requiremen- and that he/she will comply with s2 procedures and requirements. 30MEOWNERrS SIGNATURE kPPROVAL OF BUILDING OFFICIAL Tote: Three family dwellings _3.5,, 000 . cubic feet, or larger, will be require:.; :o comply with State Building Code, Section 127. 0 , Construction Control. HOME OWNER'S EXEMPTION ,v= The code state that: "An Home Owner .�,,.. ;y performing work for which � Y�uild�.n: permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that is Home Owner engages a person (s) for hire to do such work, that such Home Ow: shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for . licensing Construction Supervisors, Section 2. 15) . This lack of aware:: often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the 4nlicensed person as it would with licensed Supervisor. The Home '*Owner ac= as supervisor is ultimately responsible. , To ensure that the Home Owner is fully aware of his/her responsibilities, m: communities require, as part of the permit application, that the Home Owner oertify that he/she understands the responsibilities of a supervisor. On t: .ast page of this issue is a form currently used by several towns. You may: :are to amend and adopt such a form/certification for use in your communit::. Information and Instructions Massac'uuscits Gene.-if Laws chapter 152 section 25 requires all emplovers to provide %vorkers' collipenstaitun employees. ,qs quoted from the "1ati�'". an cnrphorcr is defined as every person in the sen'ice of another uncc- :; coi.trct of hire. cypress or implied. onl or written. An enipiurer is defined as an indi6dual. partnership. association. corporation or other legal emitY. or ally 1%%-o e: the forc�_oin�_ en__a*_cd in a joint enterprise. and incfudinL the legal representatives of dcc=cd employer, or recciN,cr or trustee of an individual . partnership. association-or other legal entity. employing employees. Hm%e� owner of a d%veflin__ House ilaving not more than three apartments and who resides therein. or the occupant of J', d% chin_ house of another �%-ho employs persons to do maintenance ,construction or repair work on such dwefl*t. or on the __rounds or 1luildirlL appurtenant thereto shall not because of such employment be deemed to be ::n er ML;_ :llantcr section _5 also states that ci-cr, state or local licensing ngency shall withhold the issu nncc ti�al of a license nr hermit to ()pence a business or to construct buildings in the conimonwealtlt for uny �c::nt Nvfio lens not produced acceptable evidence of compliance with the insurance cowera;c tequir - Ie�..ionail�. neither the conlmonwe-alth nor am of its political subdivisions shall enter into any contract for the ')c�:-Lj Fill;.::ce of public Nvorh until acceptable evidence of compliance with the insurance requirements of this cf:cc arcz_::ic_d to the contracting authority. Appiicants f!.cfc till in :he workers* caunpensation affidavit coinpictely, by checking the box that applies to your situa:io.l a sue-;ym_ _onleany names. address and prone numbers as all affidavits may be submitted to the Department of nc nai :accidc::ts f"or confirmation of insurance covera_P. Also be sure to si gn and date the affidavit. The :a. it itouid be re:urilej to the cin, or town that the application for the permit or license is being requester. r :Lc Deca;t:nent of Industrial Accidents. Shoufd you have any questions regarding the "law- or if you are req )C'Z:n a wcri crs' compensation policy. please call the Department at the number listed below. C:ty )r Fw ns 7e urc :ila: rite affida%•it is cotllple:e and printed legibly. The Department fins provided a space at the bon::, the for "ou to fiil out in the event the Off-cc of Investigations has to contact you regarding the applicant. be _ : to till in the permit/license number which will be used as a reference number. Tlie affidavits m�v be . ur7 ,:le D'partment by mail or FAX unless other arran^Pments have been made. The ,,fticc of lilvesti_adotls would like :o thank you in advance for you cooperation and should you have any q= pieZEe Jo not hesitate :o __lye us a CZ11. i i.e Depart:nent's address. teie;done and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents -• off icc n"f Investigations 600 «'asitin"ton Street Boston, IMa. 02111 fax F' (6I7) 77Z7-7749 Fitt nc =. h i- -�100 c-:r. 6. 1 or _ . The Conintonlrealth of Massachuseas lz�. Department of Industrial Accidt. is �_ �. 0 1C-V0110YOWgallo»S =�\�ii1' , 600If•a.0higrottStreet Boston.Mass. 02111 `- Workers' Compensation Insurance Affidavit aprltc•tnt inforntattori.• Please PR(NT Ie��i ],�'�"'"-'�•"'�—M"� name, Incntion- cin. nhone# I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity [f I am an empiover providing workers* compensation for my employees working on this job. emmmanv name: address: city Shone#• insurance co. noiicv if ['I I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have the followin_woo7r/kk�errss''�compensation polices: Inc omnnnc name: 60 1 V I� Un'nn j I I address• �"0 ' - N�•-r city M/I(�(� Y1S YVl ( ' �S < �� _phone#: insurance rn. 6 1 N >II CI ._..._._ ... .._ ...�. ... -I_�-pr�+_.i_.- comnanc name. ���� re- C4 i i n address: Z10 M M e NMI MA- I!hnne insurance co t 1 I n2 Y K.f YY IV l NQD nniic� if .Attach additional sheet if necessary- -•+ y�! '' ' ' ' *'" •• M= ~' Failure to secure cnvcm-ti as required under Section 35A of Nia 152 can lead to the imposition of criminal penalties of tine up to 1.500.00 ndior une scars'imprisonment as well as civil penalties in the form of a STOP NVORI:ORDER and a fine of S100.00 a day against me. I understand that a cope of this statentcnt mac be forwarded to the Office of In%-cstigations of the DIA for coverage verification. 1 tlo hereht•cerrift•antler the pains and penalties of perjure•that the information provided above is true and correct. Si_nature Date Print name Phone>* ' official use un1% do not++rite in this area to be completed by sin or roan official city or town: permit/license# r Building Department 1C3Licensing Board f (]check if immediate response is required C3Selcetmcn's Office t C311caith Department contact pen-on: phone tt: MOther s v.n.. Information and Instructions Massacliusctts General Laws chapter 152 section 25 requires all employers to provide workers' ctrntpensation for employees. As quoted from the -law-.an entplt{ree is defined as every person in the service of another under any contract of hire. express or implied. oral or Mitten. An emplt►i- r is dcf►ncd as an individual. partnership. association. corporation or other legal entity. or any two or me the foregoing enga�_ed in a joint enterprise,and including the le-al representatives of a deceased employer. or the receiver or trustee of an individual . partnership. association or other legal entity, employing employees. Ho%veti•er owner of dwelling house having not more than three apartments and who resides therein, or the occupant of the dwellin,:, house of another who employs persons to do maintenance, construction or repair work on such dwelling_ !u or out the_srounds or building appurtenant thereto shall not because of such employment be deemed to be an empioyz MGL chapter 152 section 25 also states that even state or local licensing agency shall withhold the issuance or rencival of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant v%-Iio has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements,ofthis chapter been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have anv questions regarding the "law-or if you are require to obtain a workers' compensation policy. please call the Department at the number listed below. City or-towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at tite bottom the affidavit for you to J-111 out in the event the Office of Investigations has to contact you regarding the applicant. P11. be sure to fill in the permit/license number which will be used as a reference number. 77he affidavits may be returnee the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questic please do not hesitate to __ive us a call. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents ... Office of Investigations 600 Washinaton Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 `� •�'-=• Tlrc• �t//)lll)U1111'Cltlt/t of.�fussucltutictts Depurt"Iellt Of Inds Strlul AccilICIZIS 1 office afII Ive.-W9allons ! asfiingrim Strert -'Bttstol 1. Mass (12111 Workers' Compensation Insurance AMd:avit AliPiic tit infnrntatioti Plc't5e PR TNT Lnc inn S 67- nhnn•a • ZU m a homeowner per iormin_ all work myself � — -- I am a sole proprietor and have no one workin=' in any capaeiry I am an entpiover providin_�vorkers• compensation for mY employees working on this job. T rnn,nam• nnmr- �tirirrcc• nhnnc 01 nnlir� t3 incur^nrr rn. _.__. .. am asole ,:ronrie: erneral contractor, or homeowner(circle one; and have hired the contracmrs listed beio« +cc c = . oncen comae^sation polices: /, . t cnmr:1n% nnrnr• 0-. C_ LVrJ l 1/Lei 1�—�L ,'1, ( hh.�tj 1L2 c1r, C,6 t nhnnc a rn coo in nr nrr rn � �� cum ni �•,rnr �/���tt �V Il /U� iC- , �/�' ntidrr­ 744- - clrt ".�'l I 4sl VV t /Y 1 V_„ ` nhnnc et• I�t� I Cb ' WC,C� I o0�0©2�'r rnc,lr me rn � T/V� �lA.^ ►tniie�'� Alt�:n alld;UOn11 Sh[cf 1f nettS]1r1�� � r•++•s►r�• F:ururc to s_ecurc cm cr- as required unucr Seaton:.°A of NIGL 1S-can Iead to the imposition of criminal penalues of a line up to S1.:OU.uU:n� uric c:1r5' impn.onmcnt :1. ,.ell :1s ciVii penalties in the form of a STOP NVORK ORDER and a fine ofS100.00 a dad•against me. t understand the copy Irf thi.% ,tatentcat n1a► be fur. nrded to the OJJice of Invc3tic"ons of the D1A fur coverage Verification. I do i,ere")v ccrrrli'!!!t!'Cr t IC !1i!s and pettaltirs ofprrjurt•that the information provided above it true wid correct. Datel ..turn Phone ti y�6�1 �t w c un1� do nut n•rite in this area to be completed by city or town otTicial 1 ' I` permitilicense 0 r TUti idine Department t city ar tnt�n- C: sin:Licen Huard I [_'IJdectmen'+Orrice_ ;heel: if immctiiatc response is requiredCticaith Ucprrtment ` phone t!• cost-c: ncrcnn: TOWN OF STABLE CERTIFICATE bl? OCCUPANCY ` PARCEL ID 189 090 003 GEOBASE ID 32843 ADDRESS 292 FULLER ROAD PHONE CENTERVILLE o- ZIP LOT 3 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 32204 DESCRIPTION SINGLE FAMILY RESIDENCE (BUILDING PMT #28989 PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ' ARCHITECTS.: and Environmental Services t TOTAL FEES: BOND $.00 Ox THE ' CONSTRUCTION COSTS $.00 i 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE Pc * BARNSTABLE, • MASS. 1639. A1�� ED M1d BUILD BY �.� DATE ISSUED 07,/17/1998 EXPIRATION DATE OF BARNfrf LABLE BUILDING PERMIT T. P.ARCEL "I D •_ :B9 090 003 GROBASR' ID 32843 ADDRESS 292 FULLER Ir'0 D) .:; � l:"RONOCENTERVILLE zip LOT 3 BLOCK WT SIZE DBA - DBV RLOPMENT D I STRI CT CO P, RMIT 28969 DESCRIPTION SBR/2BA,3/4 CAPE,W/ 'ING TT.2CAR CAR. 12XI.6DE, PE IT TYPE BUILD, TITLE NEW RESIDENTIAL BLDG PWT. {.ONTRACTORS: DEVLI , STEPHEN Department"-of Health, Safety ARCH ITECTs� and Environmental Services TCIAI., F ;; $331.45 % '� INE BOND = $.OD CONSTRUCTION COSTS =. $106,920 00 � �► ]0i i SINGLE FAA -HOME .DETACHED 1., �:'R."I VATE P �k+r�.� r_ � * BARN3TABLE, w ' MASS. i639, w`0� U fj BUILD ;`'G DIVISIOfN, BY DATA IS!8UED 02/19/1903 �<�XPTl2ATIC3N DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN'- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTILFINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. OEM BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRIF&INSPECTION APP OVALS &,T 2 A�� 2 ,�j �b `� � 2 1, HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH O R: SITE PLAN REVIEW APPROVAL 71,1 WORK SHALL NOT PROCEED UNTIL P MIT WILL BECOME/NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS. OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. ^; A`iy TION., G �a a t I , S YS TE —PROFILE NOT TO SCALE TOP FNON. FINISH GRADE EL , & d FINISH GRADE OVER FINISH GRADE FINISH GRADE OVER GIST. BOX .c� OVER TRENCHES ::'�►qo SEPTIC TANK ,a ..a.pO 12" MAX. .0 Q�44' A....�::'G►: .O�.OA:A�j :O';:Q.o;0 10'.v0%pD.17+bWp�i.q. a'v.o.. °a TOTAL LENGTH OF TRENCH o•.'o:p. 3„ OUTLET PIPE LEVEL ° p FOR 2 FT. MIN. 40•.O�Q p p V ® Ei v.• :.• + � :6, om0000 CCAP END 0 � �� GLC. I. OR PVC TEES ._ W " l ' . $ .00 p. ►�° P . 1500 GALLON D DISTRIBUTION BOX .�� d •a e p BSMT FL . EL . o. ;a o q° INSTALL ON LEVEL BASE �� "500 GALLON DR YWEL L S " PRECA S T CONCRETE ob H— /0 REINFORCED ��✓v s ,-E '�Q�,,v���� �c- �-� -v: �: a• ao: ).^O V.0 .Op c ;a::b •.o �►;o,Rp�;°•,a,p"o aQ�°.op p: SEPTIC TANK TRENCH SEC TION INSTALL ON LEVEL BASE NOTE' EXCA VA TE TO EL EV V. w�� OR 74 L OMER TO REMO VE AL L IMPERVIOUS MA TERIA L BENEATH THE LEACHING AREA 4" DIAM. 12" MIN. REPLA CE EXCA VA TED MA TERIAL WI TH 3" OF g �iN1 CLEAN, CLAY FREE SAND .a- 4 ...0 .d'•o. d oob° b i,'o. • 'a oo�a WASHED PEA STONE ROAD ---- C. 7�.9 `'� V li:o FUL ER '-�—�— 7z 3/4" — 1-1/2" WASHED —� �• pF �,�qJT � s_�s'g.77 CRUSHED STONE N , '- TRENCH WIDTH �A GENE AL NOTES �� 1. ALL EL EVA TION '' SHOWN ARE BASED ON A SSUMED NUMBER OF TRENCHES 1 2. ALL PIPES IN THE SYSTEM MUST BE CAST IRON NUMBER OF DRYWELL S 2 OR SCHEDULE 40 PVC. OBSERVA TION PIT 3. THE BOARD OF HEEAL TH MU S T BE NO, Q, hh CAPE COD_ SURVEY_P-344C1 WHEN , `IS COMPLETE PRIOR m ,��, __ _ \ � PERCOL A TION RATE.*, TO BA CKFIL L ING mil o �- 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED �2 MIN./IN. WITNESSED BY* BY THE BOARD OF HEALTH AND CAPE 6 ISLANDS o° SURVEYING CO., INC. RON GIFFORD /00 Q 22.00 5. MA TERIALS AND INS TALLA TION SHALL BE IN 90 Q• COMPL IA WI TH THE STA TE SA TARP BARNs. DESIGN DA TA ��n ,2. FE BRD. OF HEAL TH ppw ++o"�Nr �� s"�" CODE — TITLE V -- AND LOCAL APPLICABLE DA TE.' ✓UNE 13, 198.4 F Fu�� a�$ �' #� 2a oo RULES AND REGULATIONS _ c� E�. �; b y r'., �? :, / .ez p0 3a'�- 6. NORTH ARROW IS ,FROM RECORD PLANS AND NUMBER OF BEDROOMS '3 IS NOT TO BE USED FOR SOLAR PURPOSES s � r NO GARBAGE DISPOSAL 330 GAL . 1 7. •FLOOD HAZARD ZONE NON—HAZARDS `'� ` '� `J� DAILY FL ON TOMN MA TER 1500 GAL . �, ►� !n g. WA TER SUPPLY ey W SEPTIC TANK REO D. o SEPTIC TANK PROVIDED 1500 GAL . N s e a LEA CHING REQUIRED 7 nd a a`dca it <Bch/ �I o t ob, }'• � 'a r „«.� SIDEWALL AREA 152 S.F. w^, d. U` gQr` art 152S.F.X 0. 74G/S.F. = 112 GPD. A o f� LOT 3 BOTTOM AREA = 329 S.F. W F ees o^kmr Q 3� 439 ,S j 7 6 r o w e 329 0. 74 = 243 r.� � LEGEND S.F.X G/S.F. GPD o � f ray✓� Qa. Henry o� LEACHING PROVIDED — 355 GPD Hill� !! ea PROPOSED EL EVA TION ' ~ ti S udde N c _ ae Z b m P Rdsaa°�a B ch — G� -- EXISTING CONTOUR S'a Rd �e SINGLE FA MIL Y RESIDENCE C 3 sou r �P` d OBSERVA TION PIT ® DISTRIBUTION BOX PROPOSED SENA GE DISPOSA L S YS TEM PREPARED FOR . o o SEPTIC TANK } CEN TPA L CONS TRUC TION CO. RESERVE AREA L O T 3 (HSE. 292) FUL L ER ROAD 1p2.op ,�, ss r CENTERVILLE BARNSTABLE — MASS. N 64'21 '57'W I AV(01 cf 1. OD PIPE INVERT ELEVATION ; c +rutl,F a, _ CAPE 6 ISLANDS ENGINEERING PLOT PLAN , ` 4 �nc,fs,F; � SCALE AS NOTED 133 FALMOUTH ROAD — SUITE 2E SCALE., 1 "� '30 /c99 �- . ' ?92 > I `�, 'a — ' PLAN NO. sa-�a 9Q MAP SEC PCL LOT HSE MA SHPEE, MASS. i .n—.,...,,...T r.G.e ry;c. ..wwr.•rvry..,_.•.r-gin. _ ,,..o+ pe:+,.w u,•r.........:.. .....ax>' - ,.. _.'.,. :..m.,...., ..r•„ .. - .... . ..... ...... ... -. . - i