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0090 GUILDFORD ROAD
hr�w�wnw.n+wr."�r'wM _ �. '.� ,•�, �,... a Wn � � � u c� Aer .� q, �o � �rIIM y _ w+ yr` + .� �,�, u, , i '. • • �, E �'. P .. f 4 n �¢y n 1 S'. R . - �WE Towne of Barnstable *Permit '70� Expires 6 rw from i sue d °Y Regulatory Services Fee '* BARNSMABLE v 16 9. $' Richard V.Scali,Director Building Division ` Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 y, Fax: 508-790-6230 EXPRESS PERM APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number. Property Address U l'�\� QD residential Value of Work AMinimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name-T'���X�0 Telephone Number Home Improvement Contractor License#(if applicable) Email: -ems^ 1 hnufe-qr.C,\0Ae ji G Construction Supervisor's License#(if applicable) LCII ` b ❑Workman's Compensation Insurance Che k one: ,. a® I am a sole proprietor I am the Homeowner , x ,,, :�: ; ,i z�y Elj•�t � e . , s. i` : .� ❑ I have Worker's Compensation Insurance 0CT 19 2015 Insurance Company Name /-fi KGN'\�n L L-.-,VkGe�(�f� To W V OF�., RfUS�Tq� Workman's Comp.Policy# 00110 10 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles] All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Cl Replacement Windows/doors/sliders.U-Value 0.� 4— (maximum".32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand inspections~required. i Separate Electrical&Fire Permits required. *Where required:Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc ..a. r q ,* e% 1 ***Note: Property Owner must sign Property Owner Letter of Permission., A copy of the Home Improvement Contractors License&Construction Supervisors License is, "> require . ;SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 Of1HE MUMffrABLE, Town of Barnstable s639. � - FoA Regulatory Services Richard V.Scali,Director Building Division' Thomas Perry,CBO Building Commissioner t 200 Main Street, Hyannis,MA 02601 ' www.town.barnstable.ma.us k Office: 508-862-4038 .,+ Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder , I, 7 ,as Owner of the subject property hereby authorize �x�4 \ iM c7 to act on my behalf, in all matters relative to work authorized by this building permit application for: d,3D (Address of Job)• , • • • 1, M .. " ' /1,I� '/-/V " ,. • • 1 Signature oPOwne:r U( Date f/{ Print Name °r If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\2PI0I6HR\EXPRESS.doc " Revised 040215 I .; The Camatomtvealth ofMassachrasetts Depar wwnt of Industial Accidents Dff•ace of Inuesfigations .600 Washir gton S&eet Bmtot4lid 02111 tiJ4ptn lttass gavfdita Workers' Compensation:Insurance Affidavit:Baden/Contractor&TlectrkianslPlumbers. Applicant Information Please Print Leib - NamemusinesxhpnizatimAndimn*: �I��Q•�'�(� \1 hits ' Address: City/State/Zip: a-Yvi.o-cc Phone Qoq 1sZ9 Fj Are you an employer?ChtTkthe appropriate boa: Type of project(required): 4. am a contractor a 1_.❑ 1 am a employer with I❑ general I 6. ❑New construction. lo} s lic (fall and/or part-time).* have hired the sub-contractors 2. a sole proprietor orpartner- listed on e attached sheet 7. odeling- slip and have no employees These sub-contractors have' S. ❑Demolition working for me in any capacity employees and have wodws' [No workers"-comp.insurance comp_insurrnoe.j 9_ ❑Building addition required-] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3_❑ 1 am a homeowner doing all.work officers have exMised their 11:❑Plumbing repairs or additions mil£[No workers' right of exemption,per MGL o°mP- 12_❑Roofnepmirs . insurance required-]I . c.I52,.§1(4),and we have no employees_[No workers" 13 Other'W 1 n W comp.insurance required.] *Any app}c=tat cheer has 91 nont ab o 5ll out the sectiou belaw showing their wolkeW compensation polity infMMWfiM llomeo mers who submit this affidavit mUcatiug they are doing alt wok and then hire o=de contruturs a=submit a new affidavit indicating such. :Contractors that check this box mist attached as additional sheet showing the name of The sob contractors and state whether or not those entities Lave eatpioyees. Iftie mb-contractors have employees,'they must provide their workers'comp.policyaumber. I am an.emplaysr drat is provial rrg workers'evaTensation insurance for my employee& Below is Me policy curd job:site irtlbrmakan. Insurance Company Name: L Policy#or pelf-ins-Lic.# W OV 00 1 '7QO,9J 0 4 Expiration Bate:O Job Site Address: l® �(y t �i�( Y v Cityistate/zip: (q= Attach a copy of the workers'compensation policy duration P�a(sh.o flepo$�3number and expiration. e). Failure to secure coverage as required under Section 2 5A 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 time: of up to$250.00 a day against the violator. Be.advised that a,copyof this statement may be forwarded to the Office of ' Investigations of the DIA for insu aner_coverage verification_ I do hereby ceW tder thePm d penalties afperjnry that the inforwmatian provided aabow is into and correct: Date: Phone#: ��St� �3 ' Offi as l arse only. Do rant rwrko.in dais urea,t&be cornpWod,by cky or tartan:ar,,Qic&L City or Town: Permit/License# Luning Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk t Electrical Inspector S.Plumbing Inspector 6.Other Contact Person- Phone l#: - 6 r - 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor ; M1a �p License: CS-092944 DEREK J TIMO 12 TECUMSEH RD " Sagamore Beach MA 02i62 {: ii ili Expiration Commissioner. 04/19/2017 �,e-�ano��aancuercllf o'��aolrce�ec�ell3 Office of Consumer Affairs&Business Regulation r( OME IMPROVEMENT CONTRACTOR, egistration =152227 Type: Expiration 8/1 _. 012016 DBA TWO CONSTRUCTION DEREK TIMO 12 TECUMSEH RD SAGAMORE BEACH MA'02562 Undersecretary TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ITZ, Parcel Permit# ' r W34 �iealth Division �' - ` o� -3f Date Issued < 15)61 a .. Conservation Division CV 04 q Application F � T`ax Collector Q Permit Feed Treasurer 6 Planning Dept. d"PTIC SyS'TEA1 r, T,� l9ST )NSLED!N CO�?pL9�6�C Date Definitive Plan Approved by Planning Board T1;TEE 5 J"TZ"MENTAL COD as Historic-OKH Preservation/Hyannis T0111�� a « •e.. ��aD Project Street Address LO (3 0< l {11fL<<1t- Village Owner Address0lD �CLtGOy►,� utu�.tiyto�.w- � ttN't>P,(VA ozr�3�- Telephone I1-' Permit Request O c�- ,i )(, ID�[U1(3t9w� kco, rzy,5W r . r_ F Square feet: 1 st floor: existing�,� Z proposed 5 2nd floor: existing proposed V Total newt Zoning District (i Flood Plain Groundwater Overlay Project Valuation:! 5 0-zt-') Construction Type Qom Lot Size 16, ZW Grandfathered: 0 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: AFull 0 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 4T, new da First Floor Room Count Heat Type and Fuel: Gas ❑Oil XElectric ❑Other d -r r Central Air: ❑Yes No Fireplaces: Existing ✓ New Existing wood/cogstove: lYesZ NO Detached garage:❑existing ❑new size Pool:O existing ❑new size / Barn:❑e ting ❑mow s Attached garage:O existing ❑new size Shed: existing 0 new size • Other: i - ? � J1 Zoning Board of Appeals Authorization ❑ Appeal# _ Recorded❑ cn rn Commercial ❑Yes ❑No If yes, site plan review,# Current Use T ` Proposed Use BUILDER INFORMATION Name ) Telephone Number Address - License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR e". DATE FOR OFFICIAL USE ONLY f PERMIT NO. `DATE ISSUED - MAP/PARCEL NO. A J _ ADDRESS VILLAGE k OWNER 4 eel DATE OF INSPECTION: FOUNDATION ` /�? oN FRAME Eel INSULATION (S�jl (115)64 ,.. FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Y < DATE'CLOSED OUT w ASSOCIATION PLAN NO. P0. G DURABLE GENERAL POWER OF ATTORNEY W . DATA REQUIRED BY THE PRIVACY ACT OF 1974 AUTHORITY:5 U.S.C.Section 301(5 U.S.C.552a) This is a MILITARY POWER OF ATTORNEY prepared pursuant to Title 10, United States Code, Section 1044b and executed by a person authorized to receive legal assistance from the military services. Federal law.exempts this power of attorney from any requirement of form,substance,formality,or recording that is prescribed for powers of attorney under the laws of a state, the District of Columbia, or a territory, commonwealth, or possession of the United States. Federal law specifies that this power of attorney shall.be given the same legal effect as a power of attorney prepared and executed in accordance with the laws of the jurisdiction where it is presented. KNOW ALL PERSONS BY THESE PRESENTS that on this date I, h �,' /R� j now serving /asa member of or accompanying the United States Armed Forces at�l7Yt� � 1�P _ / /G�i'y�Q do make,constitute and / appoint %1 a f L(�j�/`7�i i" I . F�re_e rACLtq as my true and lawful attomey=in-fact to manage and conduct all my affairs and exercise the power to act in all matters in my name and in my behalf. Such powers shall include the power: 1. To lease,sell,use,establish title to,register,insure,transfer,mortgage,maintain,manage,pledge,exchange or otherwise dispose of or encumber any and all of my property,real,personal,or mixed,including motor vehicles of any kind,and to execute and deliver goods and sufficient deeds or other instruments for the lease, conveyance,mortgage,maintenance,or transfer of the same. 2. To buy, receive, lease, accept or otherwise acquire in my name and for my account,property,real;personal or mixed upon such terms, considerations and conditions as my said attomey-in-fact shall deem appropriate. 3. To transact all business of mine on my behalf including entering into contracts and the making of such investments as my attorney shall deem sound. 4. To institute and prosecute,or to appear and defend,any claims or litigation involving me or my interests. This shall include,but not be limited to,the authority to present a claim against the United States for damage to or loss of personal property. 5. To prepare,execute,and file all tax returns and to receive and negotiate all tax refund checks. 6. To execute all documents needed for travel of my family members and transportation or storage of my property,as authorized by law and military regulations;to k sign for and clear government or other quarters in the best interests of my family members and in accordance with law and military regulations. 7. To demand,act to recover,and receive,all sums of money which are now or will become owing or belonging to and to institute accounts on my behalf and to deposit,draw upon or expend such funds of mine as are necessary in furtherance of the powers granted herein. This shall include,but not be limited to,the authority to receive,endorse,cash,or deposit negotiable instruments made payable to me and drawn upon the Treasurer,or other fiscal officer or depository,of the United States. 8. To take possession of my household goods,personal baggage,or other personal property;to cause such property to be removed from any location;to cause it to be shipped to any warehouse, depot*dock, or other place'of storage or safekeeping, governmental or private, directly by orders of appropriate U.S. Government transportation officials;and to execute and deliver all necessary fomis,papers,certificates and receipts to carry out the foregoing. The above-described powers are merely examples of the authority granted by this document and not in limitation or definition thereof. However,my Agent shall have no rights or powers hereunder with respect to the following: a. Life Insurance: My.attomey-in-fact shall have no rights or powers hereunder to cancel or change the beneficiary of any policy of life insurance owned by me. b. Fiduciary Powers: My attomey-in-fact shall have no rights or powers hereunder with respect to any act,power,duty,right or obligation,relating to any person, matter,transaction or property,owned by me or in my custody as a trustee,custodian,personal representative or other fiduciary capacity for someone else. _BY THIS DOCUMENTS GIVE AND GRANT TO my attorney-in-fact full power and authority to perform every act that is necessary or appropriate to accomplish the purposes for which this Power of Attorney is granted,as fully and effectually as I could do if I were present. I HEREBY RATIFY ALL THAT MY ATTORNEY-IN-FACT SHALL LAWFULLY DO OR CAUSE TO BE DONE BY,VIRTUE OF THIS DOCUMENT. All business transacted hereunder for me or for my account,shall be transacted in my name,and all endorsements and instruments executed by my attomey-in-fact for the purpose of carrying out the foregoing powers.shall contain my name,followed by that of my attomey-in-fact and the designation"attorney-in-fact'. PAGE 1 OF 2 PAGES Unless sooner revoked or terminated by me,this Power of Attorney shall be for an indefmite period of time. I ' This Power of Attomey will continue to be effective if I become disabled,incapacitated,or incompetent. intend for this to be a DURABLE power of Atton I HEREBY AUTHORIZE MY ATTORNEY-IN-FACT TO INDEMNIFY PARTY WHO ACCEPTS AND ACTS UNDER OR IN ACCORDANCEwD HOLD HARMLESS ANY TgIR I direct my WITH to seek legal counsel in order ITH THIS POWER OF ATTORNEY, required filing or placement of notices, which may affect the validity of this'docum to determine the existence of legal requirements, such ent. Notwithstanding my inclusion of a specific expiration date herein, if on the above-specified the sixty (60) day period preceding that specified expiration date, I should be or have been expiration date; or Burin( States Government to be a milit status of"missing", "missing in action", or " riso Attorney shall remain valid and ' been determined by the Unite( in full effect until six P ner of war", then this Power o: control followin termination of such status sixty (60) days after I have returned to the United States militar3 g UNLESS OTHERWISE REVOKED OR TE IN WITNESS W�REOF I si R INATED BY ME. . ....... .. gn, seal, declare,publish,make and constitute this as and for my Power of Attorn the presence of the Notary Public witnessing it at my request this date ey in, . TOR'S SIGN URV) ACKNOWLEDGMENT WITH THE UNITED STATES ARMED FORCES AT FORT GEORGE G.MEADE,MARYLAND I, the undersigned, certify that I am either an officer having the Gen provisions of 10 USC 1044a; under which no seal is required, or.a commissioned a General Powers of a Notary Public under the State of 1 d. Before me, personally, authorized no within the territorial limits of my warrant of.lcauthority,in and r the who is known by me to be the person who is described herein, whose n subscri a o, and who signed this Power of Attorney as Grantor, and who, havingbeen this instrument was executed after its contents were read and duly explained and ee a d n duly sworn, acknowledged that voluntary act and deed or the uses and purposes herein set forth. This acknowledgment i that such execution was a free and under e uthority granted by Title 10, United States Code, Section 1044a whichmalso executed in my official capacity this ckn wledgment, or, if not an officer,by the State of Maryland. states that no seal is required on (NOTARY SIGNATURE) ARMENTHIA D.BROWN NOTARY PUBLIC STATE OF ti1ARYLAND y Cbm inission Expires April 1;2007 (NOTARY OFFICIAL,STAMP OR MILITARY RANK/COMPONENT) PAGE 2 OF 2-PAGES �OFTME r Town of Barnstable 4J G y Regulatory Services I BARPSPABLE. ' Thomas F.Geiler,Director 9 MASS. FG N1A. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. a 1 Type of Work: AIy , n Estimated Cost Address of Work:0�o G"U L I Owner's Name: t� Y� Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied 2Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ._ ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. J U L - 8 2004 / mate Owner's Name Q:forms:homeaffidav -�—� I_ 11The Commonwealth of Massachusetts . Department of Industrial Accidents' 600 Washington Street - Boston,Mass. 02111 . Workers' Com ensation.•Insurance Affidavit-General Businesses ni . •,ro.aTrp,. ..r,--w.F.t• •+'Y,y,.. .. .,. e.iva sc§1 address , -74 70 (n �Ci work site locati (fall address) ❑ I am•a sole proprietor and have no one Business Type: 0 Retail❑RestaurantBar/Eahng Establishment ' working in any capacity. ❑ Office 0 Sales(including-Real Estate,Autos etc.)' ❑I am an em toyer with emm,loyees(full& art time): Other /%//% I am an employer providing Nprkers' compensation for my employees working on this job.. f5in rieine• com - - aaaress _ -- -- .phone / I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: COIIl anynain ' phone >..:-• :p' is. JJ �4.•: h :. insurance co. - - - com'eri nisi$ _ fladress•. • .'. , •f� •:1-�••:,•:f,a: •C. ..0�3 insurance: ' �1 Fanure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 an or one years'imprisonment as well as civilpenalties in the foim of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that it copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cert', under the pains a penalties of perjury that the information provided above is true and correct Signature Date l;7 9 V . Print name Phone# official use only do not write in this area to be completed by city or town official c ity town: permitllicense# —[]Building Department . _ ❑Licensing Board ' eck if immediate response is required ❑Selectmen's Office ❑HealthDopartmeni t person: phone#; ❑Other Sept 2003) Information and Instructions Massachusetts General.Laws'chapter 152 section 25 requires all employers to provide workers' compensation for their. employees: As quoted from the 4`IW% an employee is.defined as every person in the ser"ce'of another under any contract of hire; express or inmplicA the 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,enTIoyer, 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 eznployspersoiis to do.maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such.aployment.be deemed to bean employer. .. MGL chapter 152 section 25 also'staies thateve'ry state br 16cal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements.of this chapter have been presented to the contracting . authority. Applicants Please fill in the workers'compensation affidavit completely,by checking the box that applies to your situation..Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department-of Industrial Accidents for confirmation of insurance coverage. Also'be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents'. Should you have any questions regardingIlid 'law"or if you are required to,obtain a.workers.'-corpensation policy,please call the Department at the number listed.below. City or Towns . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill.in the permit/license number.which will b�e used as a reference number. The.affidavits may.be.returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: � . . The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Wes"Nuons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 �I phone#: (617) 727-4900 ext.406 - �pF�xe rok� Town of Barnstable o� Reg datory Services Thomas F.Geller,Director 9� s639 a1� Building Division ArED � Tom Perry, Building commissioner 200 Main Street, Hyannis,MA 02601 www,totwn.b arnstable.ma.us Fax: 508-790-6230 Office: S08-862_4038 Px-perty Owner Must Corrlplete and Sign This Section If Using ABuilder of Qwner of the subject property nn�,� to act on my behalf, hereby authorize M CL� in al.rnatters relative to work authorized by this building permit application for: (Addres of ob) J U L - 8 2004 Date Signa er Print Name Town of Barnstable �tt�� Regulatory Services BARNSTABLE, Thomas F.Geiler,Director 9 MASS 0 9. Building Division rEc �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: q® 611yi 5Z I '! I C Q:(U 1 (LL number street t village "HOMEOWNER': � D�-775_?o 1 _ n-Sme home phone# work phone# CURRENT MAILING ADDRESS: !A_LL4A_Ao (��- 't fLf7L1` CAD f2L�yyLc� city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and require nts. R SignaturSQf Ho owner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states'that: "Any homeowner performing work for which a building permit is required shall be exempt from the.provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE Q square feet x$96/sq. foot x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot=. x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 - >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= - x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25..00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcost Rev:063004 NV77'Y SR O€=- DET'-�'71712 REQUIREMENTS =M'f� f,40w LAvd. ADDITION QF A NEW DEDR ; M WILL GIIA UPGRADE OF i E , le FOR THE WHW.10 � � ° PLAN ACCORY A�NL� AVEOI ELECTRICIAN TAKE OUT NE APPR PRIATE � PERMIT AT THE FIRE DEPTMEN .� SMOKE DETECTORS O.K. �y LEUILDING E T� B 41� -TI)LI %o .s g row" -- . .. . ... .... ..... . R R r� ------- ---- - � l'1 vi i IF c� i a � � f fx RkY.C204)m (�3b The 'down of Barnstable, KKAAM° t Department of Health Safety and Environmental Services '69 Building Division 367 Main Street,A9anzis,MA,02601 508.862.4038 . ' 308•790.6130 , PL w Owner: j+� Map/parcel:- 172 OS Project Address: �� �tti �'�Ord Builder: NER The following items were noted on reviewing: V q�r.'t i 1a.T1 O r• r` Gcauw, S AaL� U r 6D $ �tTtslrt 7 '� ovA P-144t -Ptav- L.EFr MUME RJp#Jar Reviewed by: � Date- � IOy We Z0 39Vd 0M06t80g% ZZ:9Z b00Z/bt/L0 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I '� Parcel Permit}'#� sg. �r -y •1.. f Health Division �© Date Issued YConservation Division Applicationee "" rez�__, Tax Collector {� -Permit Fee Treasurer ql !f 3 f® i C-r_ `--, SEPTIC SYSTEM MUST BE Planning Dept. INSTALLF�-; IN ('OMPLIANCE Date Definitive Plan Approved by Planning Board T.I. ENVIRG;= f 1 "fir AND Historic-OKH Preservation/Hyannis TOVVw n ;,;.�., ♦S Project Street Address Village �� f'�Y'►/0 Owner Address Telephone Permit Request X X/2' �e,Ck— Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 'CeO00 • Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family U"' Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes al<o On Old King's Highway: ❑Yes C110 Basement Type: bull Ll Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing l new / Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count `7 Heat Type and Fuel: atas ❑Oil ❑ Electric Cl Other Central Air: ❑Yes &r'N-'o Fireplaces: Existing ✓ New Existing wood/coal stove: ❑Yes BIN Detached garage:❑existing 0 new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:lexisting ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# : -.Current Use - ,:., •Proposed Use BUILDER INFORMATION Name—_j o u�yye, ;�,, Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE 4 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS' _ VILLAGE OWNER DATE OF INSPECTION: , FOUNDATION-- 101 0v A.44 ® 16146YAV- v FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL f. GAS: ROUGH 7? FINAL FINAL BUILDING n } C rr DATE CLOSED OUT- . ASSOCIATION PLAN NO. , rn g r p�(}{E owa of B arnstable ' Regulatory Services. �asTe $ Thomas F.Gdier,Director AI MA Building 1*ision • Tom Terry,Sullding Commissloner' ' 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 permit Data- ' AFMA'YZT , HOME DOROYEMMNT CONTRACTOR LAW SUPPLEMENT TO PERMM APPLTCATZON • MQL n.142A requires that&a"reconstruction,alterations,renovation,repair,modernization,conversion, • •iaaprovajaent,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than fora'dwelling units or to structures which are adjacent to •• suoh residence or building b e done by registered contractors,with certain exceptions,along with other requirements-Type of Work: X/Z. Est=ted Cost 000_ 60 Address of Wank: g0 ��-C��9��D�• �1 ( P-��P�'I//���. �`7� ���Z Owner's Date ofApplication;, �/...3,/a� ' • ' I hereby certify that: Registration is not required for Ea following reasons); ' []Work excluded bylaw []Sob Tinder$1,000 ' []Building not owner-occupied 26wner pulling own.permit , Notice is hereby given that: OARS PULLING TEEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR AYPLICAB„IiE HOME RaROYEMENT WORK D 0 NOT BM ACCESS TO THE AMITRATION PROGRAM OR,GUARANTY FUND UNDER MGL c.142A, bIGNED UNDERPENALTIES OF PERJURY Ihereby apply for&permit as the agent of the owner; Date Contractor Name AeQistratxon No. 0 's Name The Commonwealth oflVlassachusetts . _ Department of industrial Accidents' • _ OA96�afhstx�sd�ed�s' 600'Washington Street Boston,Mass. 02111'. Workers, Com ensation.insurance Affidavit-General Businesses / // / .pu .a / :ti;, /':"a;snp,• .T}e.-+yF.,,•''TM1r. .. ...• •' ►'.i- -:, ,.•s 'a*•31 _ / Cam.• state:' zi :Q.Z.�� hone#y .. _ .. . . . .._ work site location full address [] I am•a sole proprietor and have no one Business Type: El Retail❑Restaurant%BaAatin'g Establishment working in any capacity. ❑Office❑ Wei(including.Real Estate,Autos etc.) ❑I am an em toyer with employees(full & art time: O th e r uJ r . I am 5loyer providing workers' compensation for my employees worlang on this Job.. ,�;�+ :.ii;�•af+rl:s'•. a'•1' •t' i(i•t' '+5:; :s. :sa�,.n. G +.s•-"-h%" x r7 1':r.,;ni. :1: r;.7' •`'"::`.. �, coman'•name• :; ', ,; ^:J••- - • +,.L t,, •��� ,� .s.'• .. ;4, :JL. �,„•:Lr: ., 1.. tits;,•i`... i:;: 'i�7i:r:' :. �.. �� -:fit•: •.5::•t'xii.:r•' _ •.i+..'. .•`;..is:� '�R..:, t'�:i+:�ti:1°• ii}'+'t:i+�++t+. •}.:� r7':.�•,;!r • aaaress: 'i L •l'llr 'J, .'•7 ,•t•' ,:t• 'a. •.k 4:•' ..:' � .+ hone..#.::,�:�': �'. J .�'• • 1+ '• .�: . . ;.�.+ri.+''L: is+• t',�-'S.+� p�'F'�,•.#' •`•i,:' t•••�' 4arice cr`' '`..t:^._;''(,L:.�n _•. r ':.:..,+e:•T:y�•ti.ti ..•+; '.•::�•'. : ...:: •.,.�.�:, • :_..:,::. ..�.::,`..; 'Jib U1 / gi TD I am a sole proprietor and hsve hired the independent contractors listed below who have the following workers' .compensation polices: ; ' "�.{: :•tt•,7• - ,x:•1.• •y' .'t:.• sx• L'f: •t:', ..,�+.,y;:. - ::.rx SY ri,�..�t;:ti. :n,.i:�••':�i:: 't COIR}9II II&I[S�: a �.+:.,•� t. 3,;• :•,•.'::aYr:.: ,fir r - _ sic..,• f ,:•,, � •sJy.,:'�'s.,,Sy, �' 'x;_'�.•:;f; .t. :'i'• .tr' ..L 's'' '+?.,�,f,•a:i• } ,+'' s' .t ;i •t' +' 'ri.••' :(� :j„C�::��?}�.:;: address: .V• :�+' '•4•.r, � '' �+�'+'t� 't • x' r •:.�. LA i7_••,: :''a:''i':}':. .{:.;:? ,,:.l• ,' ,,xx �.{1��. .i%,• •i:r.. i.m•t' -sS '•L•'`t.� Cl .�,,.. :.�,,. .:i:•`r•i.r C••h.'s:i Li;4. :�i:}..•,:, s:. +;ti';+::sue ,.i..+`j:h::f,+:;, •'s:• , COL ' :ytt 'f. .,,.e:' •:.. iS�;��;'•;L :';:• '�:' Folic :#�' .t, ,.,.:.i.r•.i':�• :�;, ��•,.:;.•.• ius`ursnce'co. :•:; =a�. %�//��//%�%il t. ,t•�.t 'L:•::' s,r ''r•.':.� •'r,•t,,•'{,L+.,��+':�1•i. •p s.+ f.y.....'•!�.:t:'•'•: s•. _„�•;L.,•• ,• _ ; ' + • Jt.., .ti.. '!i:s.:+' 4'. ::••tip .T;LLt<.•'. .{.• ' ' .�1 OIiE� J 1 •�� •t� t'•'t • . i•Sy} tir '�} ,j'.�- i.k•..:rp•`.;,•"7::'l. '+i.. �.57+ �%.•�. s•••.Tq•.. "` .,:�.' ..." .:�.? , incur"nc Fatiure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties or a fine up to 51,500.00 and/or one years'Imprisonment sa well as civil penalties in the form of a STOP WORK O1tDER and a fine of$100.00 a day against me. I understand that a t may be forwarded to the Office of Investigations of the DIA for coverage verification. copy of this statemen I do hereby certi the nalti 'ury that th- 'nf brmaiion provided above is Prue and correct, Date '�� �G Sign ry•' . .Print name Phone.#�•s6� `" �J official use only do not write in this area to be completed by city or town offlew city or town: pgrmitflicense# ❑Building Department . ty ❑Licensing Board •cheekif Immediate response is required ❑selectmen's rtmee ❑Health Department , contact-person: Phone ir; ❑Other _ (revised Sect 2003) Inforniation and Instructions. achusetts General Laws chapter�152 section 25•requir Mass es all employers to provide workers' compensation for'their•. . As quoted fromthel law' in, an employee is.defined as every person the service of another under any contract l achli of hire, express or imp lied; oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or mare of the foregoing engaged in a:joint enferprise, 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'inore than three apartments and-who resides therein, or the.occupant of the dwelling house of another who employspe�:sbris to do.m nc aintenae, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment.be deemed to be:an employer. MGL chapter 152 section 25 also'states that'every state'or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.cOmmonwealth for any applicant who has er the- not produced acceptable it pol political subdivisions li i ns with the enter into ane contract for th performance of ublic work until cot=nonwealth nor.any.of its p olrtrcal subdivisions shall Y acceptable evidence of compliance with ,the insurance requirements.of this chapter have been presented to the contracting . authority. I APPlieants . . Please fill}in .the workers' compensation affidavit completely,by checking the box that applies to your situation.:=Pease supply company namea an P address d hone numbers along with a certificate of insurance as all affidavits may be submitted to the Departnnent•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 I)- E[r rent of Industrial Accidents. Should you have any questions regarding'the'"law" or if you are required to obtain&•workers'.compensation policy,please call the Depart*nt at the number lists below. City 0r Towns . sure that the affidavit is complete andprinted legibly. The Department has provided a space at the bottom of the Please be affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to. .fl.in the perrrntTicense number.which will be used as a reference number, The.affidavits may.be'.returned to. the Department by. °r 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 questions, ' please do not hesitate to give us a•call-. j /. / xx The Department's address,telephone and-fax number: The Commonwealth Of Massachusetts, Department of Industrial Accidents tit�ce of Ua>fesff�atiens ' 600 Washington Street Boston,Ma. OZI11 fax#: (617)727-7749 �I phone#: (617) 7274900 ext..406 I Town of Barnstable vppKHrtTOk�o� Regulatory Serdces Thomas V,Geller,Director t ldfn.g DMSIOn r�D Tom Perry, Building Commissioner 200 Main 8tceet, gym, A 02601 . - www.ta�tm.barnstable.maus --. Fax: 508-790-6230 pffice: 509-861,403 8 - ProP er. r 4umer Must ..Complete ana Sigma:This Section ... if Using A.Buil.der as Owner of the subject property to*act on mybelialf; _.. hereby authorize . :. ers relative to work authorized by budding perrrAt application for - . in all.matt -- - 9a C Address of ) - r, ate. is er ��intl�Iame . BxM�l cK 4 it _ s 1 ' S L ,4. 0-1 Lk O 0 4, J, � s I D , to � �r qO �o�-77� �6��1 c t � t M• - -'--_.._ ..___--- -- - -_. ...... ---_.... - ..... -._...... _... '.. .._ --_-- ---......_- -- ---------- , .� f + Town of Barnstable Regulatory Services RAMRrAMX i Thomas F.Geiler,Director MASL I 94 .•� Building Division ArFD�p Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma:us Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION / Please Print DATE: JOB LOCATION: q6 number Jstreet village "HOMEOWNER': L—/s"I�Gt� /' 73 '01_5 �O4 9�0 —JCS�7 name //�� home phone# work phone# CURRENT MAH ING ADDRESS: 9a C�/u./� ram/ e;�� o2& 32--� city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and ,to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a_one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official.on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and re uirements and that he/she will comply with said procedures and require ts. Signs of meowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:fonns:bomeexempt I '1 1Pt .r.d i Cemr'�'�t1@ S � . . j -�3p r w Alm k o ^i Y Town of Barnstable IKKE'°'y,.°� Regulatory Services Thomas F.Geiler,Director 9BARNWABLE.�q Building Division 1639.Mpt a Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 COMPLAINUINQUIRY,REPORT Date: l l 10-3 Rec'd by: Complaint Name: Map/Parcel 1 l a DS�p Location , Address: q ��L L Originator Name: '' t Street: Village: State: Zip: p• Telephone: n c Complaint Description: - '�e rj 00 1 vt l 6-C 60rd t FOR OFFICE USE ONLY Inspector's Action/Comments Date: l` ( � U 3 Inspector � - a CP Jtoo, U _ p I C) ��1 S l/J e-e--k (�a P 1V Pi,4"L' ,Z Ue t U� ( �� �.� a U h k l S. c,l-n_Q t o �V"(--e C( L Lu Y) Additional Info.Attached t lr V a , Town of Barn �,R�astae�E Regulatory ServiiOR 1 Z pM 2. 32. Thomas F.Geiler,Dlre"M BARNSTA13M ` 9 MASS. . $ Building Division prEO 39. A Tom Perry,Building Commissi er s��i�iS1aN 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERNIIT# VS 60 FEE: $ SHED RE GISTR ON 120 square feet or less y � �� � � � �/ �-' G i-OQJ l,�Da 1C l 1✓ Location of shed(address) Village. a Property owner's name Telephone num er Size of Shed Map/Parcel# Si afore Date '.,. Hyannis Main Street Waterfront Historic District? b Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) uired) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY'A PLOT PLAN (-- 6 Q-forms-shedreg ` REV:121901 ®CALIF 1 O N.- aC3 PE a Lo MAn o A.ccu R^-FE STANDARD LEGEND NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES • EDGE OF BRUSH 17 ORCHARD 0 NURSERY CHA D R R ERY MAP 172 1 EDGE OF CONIFEROUS TREES MARSH AREA 19 :. ," •; _..... OF WATER EDGE Q - DIRT ROAD t �� DRIVEWAY PARKING LOT PAVED ROAD O - — — DRAINAGE DITCH — ——— PATH RAIL P PARCEL LINE MAP326 E—MAP# Iw ,� 1 �� 021E PARCEL NUMBER V I #367 �HOUSE NUMBER O ........ 2 FOOT CONTOUR LINE j O 3e3 10 FOOT CONTOUR LINE 90 Elevation based on NGVD29 5E f /�/J ; a.9 SPOT ELEVATION c x STONE WALL X___X_ FENCE w RETAINING WALL MAP — RAIL ROAD TRACK _...... ."." _ 01, ,_- -_— STONE JETTY Poo'.; SWIMMING POOL AP72 # PORCH/DECK 0 BUILDING/STRUCTURE �Ir 5 "`----��� L�F: DOCK/PIER f 100 HYDRANT Oe VALVE O MANHOLE o POST OF' FLAG POLE T O W N O F B A R N S T A B L E G E O. G R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N :II T - .o SIGN ® STORM DRAIN w PRINTED SCALE:IN FEET *NOTE:This ma a an enla ement of a **NOTE:The arcel lines are only graphic re resentations DATA SOURCES: Planimehits man-made features were interpreted from 1995 aerialphotographs b The James a TOWER p" r9 P Y9 P P ( ) P Y 0 UTILITY POLE w ie 1"=100 wale map and may NOT meet of property boundaries:They are not hue locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 20 40 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimehics,topography,and vegetation were mapped to meet National Map Accuracy Standards LIGHT POLE O ELECTRIC BOX s 1 INCH=40 FEET* enlarged scale. on the map. at a scale of 1"=100'. Parcel lines were digitized from FY2004 Town of Barnstable Assessors tax maps. 8)-e ws Ack TOWN OF BARNSTABLE 219RNSTLELE. Mann 1039- AV. BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....SUI.-Id.... ......dwidlil. ............................................... TYPE OF CONSTRUCTION .................. ..................................................... ................19.2-2, TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for as permit according to the following information: Location ..... ........Co., ......ka..4.d.............. fe,t:V 1 1.I.e................. .... .............. ..................................... ProposedUse ....... ........................................................................................................................................... Zoning District .... .................................................Fire District ..&&j 'jle Name of Owner ...N0.9.P.1f.S.t...NAPM.e.A........ Nor....Address ... ........... t ���! �1�1/Ij�� ............. Nameof Builder .......TA kn..e.............................................Address ..................................................................................... Nameof Architect ..........N.Q.N.-12 .........................................Address .................................................................................... Number of Rooms .................16..............................................Foundation ....... ...... .................... Exterior ................ 6/Oial-AI. ................................................Roofing ....................ke 041q.. ......................................... Floors ... W ........... ..........................................Interior ............... g 51- ...........(41 4— . .4....,.Q2 Heatin ........................................Plumbing ...................................................... ........................... .. ....... Fireplace ............ 0-0 .011vell..........................................................Approximate Cost ... ..... ... .................................... Definitive Plan Approved by Planning Board -------------------—-----------19--------- Diagram of Lot and Building with Dimensions 4 k.,e, C)—e.) SUBJECT TO APPROVAL OF BOARD OF HEALTH -iy- < ul 0 10 0- < <_j L'i N Z ( < -T- i— LY < M M L'L LL 0 :S- LL- LL (i C) u� M LLJ 0 C F- a) LU LIJ D LIJ < Ljj LjJ Lo Cn LLJ LU 4-0 < < 2: loci < I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nome . ..................... Normest Homes Inc. y No .15538 .. Permit for ..... one story ' single family dwelling ............................................................................... Location`O G' ilddord Road ........... ................................................. ' Centerville ............................................................................... Owner Normest Homes Inc. ................................................................. 1 frame i Type of Construction .......................................... ................................................................................ Plot ............................ Lot ..................1..7............ I i Permit Granted ......September 27 ....19 72 Date of Inspection ...��i�2rr. ..Z19 r Date Completed 19 �r... a, C�9� i p PERMIT REFUSED 1 ................................................................ 19 ............................................................................... M ................................................... ........................ s ............................................................................... ............................................................................... 5 Approved ................................................ 19 ............................................................................... ............................................................................... s i. ........-------- _ _.------ — c" 1��� y' 'rosy w��t � - y - , i ax 10 ,o v S� i ! L X i °1+4 Cx �W�O Au QD S 1, w - ---- = -- _ _ rU w A od E3� 1 1 , y� --,.6 b [ID l-� ru r. e h K u I y . •J , C-1) � f� fib-= V.O 1 JUL-12-2004 12:49 CCF,POD, IMS 301 677 2706 P.03 JUL-12-2004 12:49 CCF,POD, IMS 301 677 2706 P.02 y 1 !' FLOORPLAN Borrower: LINDA PERRY File No.: 0032282816 Pro ert Address:90 GIULDFORO ROAD Case No.: Ciry: BARNSTABLE State:MA Zip:02632 Lender.WELLS FARGO HOME MTG. INC.•2029 Sketch by Apex IV Wlndays*" AREA CALCULATIONS SUMMARY LIVING AREA.BRFJ>1mOWN Code Description Size Totals Breakdown Subtotals r' CSSl ririt Floor 15e0_00 1S80.00 Piret Floor 2a.0 x 62.0 1488.00 2.0 z 46.0 92.00 r r 62.0' Bedroom Bath Bedroom Bedroom o Family ' t N F r N TOTAL LIVABLE (rounded) 1580 z Areas TO>al(rounded) 1580 Kitchen Dining Living Room • 4 . 16.0' 46.0' 4 - TOTAL P.03 ' i N SITE PLAN SCALE: 1."=201 BENCH MARK ON THRESHHOLD of REAR- SLIDER, ELEV.m100.00' (ASSUMED) O� 0' Paved driveway O . J v T N.T G ' x 97 ' �°� ap Gj'� �� by ee Vb ."pads 9831' 95.68' 97A X 97.94' LOT '174 �. ,° AREA = 15,254t SOFT. eNKPROPOSED LOCATION OF RELOCATED SEPTIC TA O (INSTALL I,500 GAL H-10 S.T. IF EXISTING S.T. IS MACCESSIBLE OR STRUCTU UNSO ex ('g 7.31, 97.44' 97d ls? 0 B' existing x SAS 97.43' •,s 9"4' 3-Ir OUM.ACM%W410113 10' or 0 5 r 9G53' STEEL RMFORCED PRECAST CONCRETE PLAN VILawEW mq.usaww etttr ed� Y rah mMt to sued 4. ar.d. GAS CROSS SECTION H-10 1500 GALLC NOT TO. USE ACME PRECA Existing Dwelling house to in. tic tcnk NOTE: ALL PIPES ARE TO BE 4' DIA. SCHEDULE 40 P.V.C. �P NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE. It First Fl. EL-100.D0 „°g no Ddww� Finished grade over system-2X elope away5 HOLE , cellar • OIST.BOX Existing Orade Vev.-87't Wall 0-eax eover moat be man.2•-1/e•-1/2• PIT cover must be raised to r. f 5-.02' mtai within e•of lahed grade doWe washed atone within t1• finished grade ! LOW far r 23 PROPOSED s S•.01 LZJ VI SEPTIC TANK 10 ey et 8 e o r t s HGAOSB oeeeo r 12 cl o e• -51 8.OF 3/4'-11/2•STONE > �> II d C Cro 0 SYSTEMo Scale PROMO r OF 3/4•—It/z•STONE Not EXISTING LEACH PIT } I N SITE PLAN SCALE: 1"=20r BENCH MARK ON THRESHHOLD OF REAR SLIDER, ELEV.-100.00' (ASSUMED) O ' O� O Op O• Paved driveway O O e Op J v '' X 9788' �?AoC5 ae, +% O' •�'`��i,y ry existing g ��e Q��. concrete patio 99 31' gym 4 9SbB' 97 X 97.84' e+� LOT 174 eo a AREA = 15,254t SOYT. 3� PROPOSED LOCATION OF RELOCATED SEPTIC TANK O (INSTALL 1,500 GAL H-10 S.T. IF EXISTING S.T. IS INACCESSIBLE OR STRUCTU UNSO 1 ex�ing 7.31' 97.44' 97.1 r 0 2B' existing ' SAS 97.43' 00 00' 96.64' / 3-2(r DIM.A0235 VJVW Ls iC d . y 96.53' sm 0 1 7 STEEL REINFORCED PRE=CONCRETE PLAN VIEW 3-2r RDW a aoYans Min.e.amo. p� v-ia — �'ash Met to cutlet s. c erT— L lzxr,;cz.- y .. 7-a. CROSS SECTION H-10 1500 GALLC NOT M. USE ACME PRECA Existing Dwelling house to in. from tank NOTE: ALL PIPES ARE TO BE 4" DIA. SCHEDULE 40 P.V.C. septicNOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE. First Fl. EI.=100.00 g nof finmowemw We& Finished grade over rptem-2X elope away 5 HOLE cellar N25 XIS71 DE DIST. BOX Existing Oro&Elev.-97't wall D-Box oover must be Yin.2'-1/8"-%2' PIT cover must be rafaed to i within s'of (shed grode double washed atone within 8' finished grade 2'max Levd war 2 ' PROPOSED 5 S•.o1 i'500 10 SEPTIC TANK ' 1 oepH-10GAS0000 OF 3/4'-1l/2'STONE a s (I o 0 0 0 0 5 eeeee a oeo e SYSTEM PROFILE °-OF 3/e-111r STONE Not to Soule EXISTING LEACH PIT c ell "CENTERVILLE" N S ITE od _ gsh�e Or �Qd a b. of �a 0 e 0 2' c a LOCUS NO SCALE GENERAL NOTES 1. ADDRESS: #90 GUILDFORD ROAD 2.. ASSESSORS NUMBER: MAP 172 PARCEL 056 3. DEVELOPER'S LOT: LOT 174 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN ON THE GROUND INSTRUMENT SURVEY. 5. TOWN WATER IS PROVIDED TO SITE & SURROUNDING PROPERTIES. 6. REFERENCE PLAN: PLAN BOOK 247 PAGE 84 7. NO WETLANDS ARE LOCATED WITHIN 200 FEET OF SAS. 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS. CONSTRUCTION NOTES 1: Contractor is. responsible for Digsafe notification and protection of all underground utilities and,pipes `T 2. The scp5c Look onq Jislu ibutio.i box shall be seL level on 6" of 3/4'-11/2 stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation by Glen E. Harrington, R.S. 5. The contractor shall install this system in accordance with Title V of the Massachusetts Environmental Code and the Regulations of the Town of Barnstable. 6. Provide an Acme Precast H-10, 1,500 gal. septic tank (if necessary), and 1 H-10 5—hole Distribution box or equal. 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. 8. Install gas baffle or equal on septic tank outlet tee end. 9. All existing inverts and site conditions shall be verified by contractor. 10. Existing leach pit to remain. 11. If existing septic tank is inaccessible or structurally unsound after relocation, install new H-10, 1,500 gallon septic tank per Title V. ,r ncr X-C ma. • L*W dopM NOFMq PROPOSED SEPTIC TANK RELOCATION PMPaRM FM END—SECTION � LINDA M. PERRY =PTIC TANK 0 y AT LEGEND ,qF 070�o #90 GUILDFORD ROAD 3 EQUAL OEXI ONGRNH PIT �QN1TA �p• BARNSTABLE (CENTERVILLE), MA PREPARED BY: - 0EPTS°o HR1 SE ,CTANK GLEN E. HARRINGTON, R.S. X 104.46 DENOTES EXISTING 9 LE DA ROSE LANE _ SPOT GRADE MARSTONS MILLS, MA 02648 95 EXISTING CONTOUR . TEL 508-428-3862 _ sd APPROX. LOCATION FAX: 508-428-3862 EXISTING WATER LINE 6 6 — APPROX. LOCATION SCALE: 1"=20' DRAWN BY: GEH JUNE 10, 2004 EXISTING GAS LINE DATUM: ASSUMED FILE: PERRY SHEET 1 OF 1