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0391 HUCKINS NECK ROAD
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I hRi, i" N f mg �1 IP;111.Ao-T Y*)� ; jqv, I it A i j '22 i- �1 V -,)) d'OTM,;5"U fAIV 11 I MWIT z 44.1 � *wn of Barnstable *Permit# � 71 o ' �, Aegulatory Services fee 6 months issue dat MUttvsTeBL ° 14 Mass. Richard'v.Scali,Director 1659. a� Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press.Imprint Map/parcel Number 0� "I Property Address .�� kb)(Y-�1 c5 ,\c(Y-- K6 (t 1 16 l I MCA [VResidential Value of Work$ 5W (} Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 3` 0-u CC'ns Wt �W cm a v i I c- MI. Contractor's Name M� . Telephone Number o 0�q -q q Ln(O Home Improvement Contractor License#(if applicable) O O (* Email: H(e �`AOL LOn. Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance rk one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name P —T�(� �S Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. ' Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to QY-e-roof(hurricane nailed)(not stripping.-Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. 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. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is yy�required. SIGNATURE: QAWPFILESTORNIMbuilding permit forms\EXPRESS.doC 06/20/16 1 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-102185 Construction.Supervisor KARL T SPAIN k 46 MAIN STREET SANDWICH MA 02563w j 22 tK� �it,� - Expiration: % Commissio er 12/26/2018 • �/e Tpoa�emaoruaeccLt�i o�C�/v�ar�aac�ic��eLL3 q `-' Office of Consumer Affairs&Business Regulation :- HOME IMPROVEMENT CONTRACTR Type: + Registration, °177767 o Expiration 2/312018 DBA K.T:SPAIN CONSTRUCTION 4 KARL SPAIN 46 MAIN ST- SANDWICH,MA 02563 Undersecretary 14. _ License or re before gistration valid ror Office the expiration date. If fo �adividul use only Of Consumer affairs and and return 10 Park Plaza- Business Be o, Boston Suite 5170 gulation Ma 02116 C 01 of va id with ignature The t;amntamveakt o,f Massr diuseffs ; Department�t,f lardiisttid Acc id ews f .ce gf£ntgaticau. 600 Washfivion Shreet ` Boston,MA 0211I ' kvrvw�ma�g��dia WCWIMrs' C '3ensafian Insnrxnce avit:BmflderslCntractars/Fl ianslPbnmbers Applicant Informafign Please Print�e Y Address: Plume Are you an employer?Checkthe app opriate b ' Tyke of project{rem}uired): I.El am a employer with 4 [YrI aaf a gem mat embMaas and I 6. ❑Ne�v oohs on employees(fa]Iaudforpart�limef.* baveluredtfie mb-coat actoas . 2.El I am a sole pzoprietar orpartner- fisted oatire attached sheep odelizzg shr p and have no employees These sib-coaEractors have 8_ ❑Demalifion. .. w,,,{,i�,,, forme is employees andbave worms' 116L3ei �y�� l 9..❑Building addition, [No Wad'comp_inswznce comp-;n'sura� regu and� S. ❑ We are a coaporatim and its 1 ❑Electrical repair or additions . 3.❑ I am homeowner doing atl work officers have exemised t 1L❑Piumbingrepaiss or additions nxyself[No worms - right of exemp6m� §I{ we r M(ave noU❑Roof repaim insurance required-]1 employees.[No wos�s' 13_❑other cam-ms—^.c„reqJjre&J #fAnyapp&c=&atc&c1sbosK—St alsa fill o itbeswdembdawsh flie¢worcezeco=-581; apoficgiz5M=d= Hameawnemwbasabmvtd zT1dnAim gdayaredamgOwoken&denldMautd&Care„S— Mb=1tanP6waffidxvftmdirtiaaeach_ TCantmctosffu1rber1Yt1YisbootmustavarheamSea;e;amslshedamingthenameofthesdb-cc=xcM=andstatewhe&erornotftsee fitksb.m employees.Iftbebab-caatm bm emp1byw_,dLey=1stpmvide xbe r wudEe&gyp•ply ai er- I am are eaipT ar floatis prmjrdirrg muar&ers'cotnrperesafiarn urszirance jnr my eu�vla}�ee Retow is f iepaticy and job 5*0 in�arrmafian. ' Insurance Company Name: PORGY or self--ins.Lin FxpiratianDate: Job Site Ad&esm QtylStaweap: Attach a--opy of the workers'compensationpoH4 declaration page(showing the policy,amber and expiration date). Failure to swam coverage as requiredunder Se ction 25A of MO_c�15 Can lead to the imposition of criminal penalties of a fine up fo$L,50D OD a=Vbioni:y&irimprisonmenk as well as tivril penahies in i e fb=of a STOP WORK ORDERand a flae of up to$250-tom a day against the violator. Be adinsed fat a copy of this statement may be;£xwarded to the Office of InvesEgations of the DIA for insurzce coverage v on_ I do trereby cwtyy un&i dw pains and penahies sfled 3'thatthe infarmadmi-prm i&I abmv is him and correct Date Z2�Phone Ojai see 4anly. Do aiat wrife in figs&va,€rr be-wwpteted by chy artown axfjrc&l CRy or Taws: Pe�cedse Issuing Aufltarfty(circle oste): 1.Board of IffeaIili 9 BmVm Department 3.Grown.Cterk 4 Electrical Inspector S.Phrsabmg Inspector & Coact Person Phow#' - 6 laformation and lastructions Ty&%mchusct s Gezaeasl Laws cbaptea M reganrs all eupIoyers to provide We compenSaftan fnr they employees. Pursuaatto this sty,an mploy=is defined a s"_.evergpersonin ffie service of another under any contact of hire, express or implied,oral or wrifiu f An errp&yer is defined as"an individual,partnership,assoc Liao,corporation or other Iegal entity,or any two or more of the foregoing is a joint a nte�se,and including the legal represe ves of a deceased employer,or the receiver or trastee of am mdividnal,partnership,association or otherlegal entity,employing employees. However the owner of a.dwelling house having not more than three apartments and who re=ies(herein,or the occapant of the - dwrMag house of another who employs persons to do maituance,c nsfmrt on or repair work.on such dwelling House or on grounds or grou or building appmtm ant thereto shaIl not becanse of such employmcut be deemed to be an employes" MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall wi-fhhold the issuance or renewal of a liceme.or permit to operate a business or to construct buildiogs m the corumanwealth for any applicant:who has not produced acceptable evidence of compliance with t=insurance.rovexage regQired_" Addffi.ona.Ily,M(z'L chapter 152.§25CM states¢Ndber the nor a'ny ofits political subT17L--ions shall ester into any can rad for the perfsm.ance ofpublic wank until acceptable evidence of compliance with the insurance._ MCi==eafs of this d3aptnr have been.presence to the confra anfhoZty." ppIicants Please fffi oi--± the wo3as' compensation affidavit completely,by checking$e boxes!hat apply to your situation and,if necessary,amply sub-� r(s)name(s). address(es)and phone m=ber(s) along w&their=tifiicee(s) of insurance_ Limited Liability Compam es(LLC)or Limited Liability`Partoessships(LIP)with no employees other than the members or partams,are not regain d to carry works&compensafron igsorance. If an LLC or LLP does bane e to the Department of Industrial ' is Beadvised that this affidavit maybe submitted eP eanpIoyees,apoIicy requned. _ _ Accidents for co of inn r-�,rr.coverage. Also be sure 10 stglz and date the zflz7rt; Tlsc affidavit should be m maed to the city or town that the application for the permit or license is being requested,not the Department of t TnrTnatrial..caident?_ Should you have any questions regarding the law or ifyou ate requiredto obtam a wormers' compensation policy,please call theDepmtncn±at the number listed below. SeJf-iasored companies should enter their e on the - line. self-ice license� Apr City or Town Officials t - 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 till out in the event the Office ofInvesdgations has to confactyonregmi:mg the applicant. Please b e sure to fM in the pennrt crose number which wM be used as a mfzrpace number In addition,an applicant that must sabmit multiple pewlicense appIitations in any given year,need only submit one affidavit indicating cua-rm policy information(if necessary)and undra°Job Stm.Afdress"the applicant should wide"sII locations in (may or town) '•A copy of the-affidavit that has bee officially stamped or maticed by the city or town may be provided to the ' applicant as W roof dLat a valid affidavit is on file for fimse permits or licenses_ Anew affidavh must be filled out cart - year. here a home owner or cifizen is obtaining alicense or permit not related to any buC1Tesc or commercial veo um a dog license or permit to bum Ieavm etc.)said person is NOT rmlahrd to complete this affidavit The Office of IuvcsHg','aiirms would HIM to thank you k advance for your coopedion and should yon have any questions please do not hesitate to&e us a call. The Departmenfs a.d rms,telephone and fax m?mbea: Cammmwmal*of Massar,3.�n eM . _ �cif Izid�al Ac�d�nt� of lnvesqt�kati=s �4�ashmg�n t Ta A 617' -4 QExt 406 or 1-�M-MA A E . Fax 9 617 727 7749 Revised 4-24-07 W �'ME Town of Barnstable Regnlatorp Services - E Ras.vcrjR{g E Tress Richard V.9=4 Dirednr � ems- tim �,,,R tart DIYISl0II • TQMrerry,EmIamg Ca oner 200 Maim Street;Hymmms,MA 02601 www tDwn:b rmstablema us Office: SOM62-4038 Fay 508-790-62M Propeify Owner Must ' Complete and Sign This Section if Us=A Builder �_ - •(,� ,as Owner of the subject property be�bya boicze j U�1CA� 6ja C1S l(1 to act on mybehal� in all mai-ters relative to work authorized bythis biulding Pe'it aPPECation for. . (Add=ss of Job) ``Poolfences and alarms are the responsibI -of the applicant Pools are not to be filed or idized before fence is installed and all final ' inspections_are performed and accepted. Signature of ChM6 Signature of App& „r r I'Z=NaLne Pzi=Name r Date'. Q�oAMS OWNE"EPOSS Ie0OLS ' NOTICE W NOTICE TO 0 TO EMPLOYEES �� EMPLOYEES 7C' `0W 0,9M SV� v The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts 02114 — 2017 617-7274900 --http://www.state.ma.us/dia As required by Massachusetts General Law, Chapter 152,Sections 21,22&30,this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PUUB-0114N13-4-17) 02-08-17 TO 02-08-18 POLICY NUMBER EFFECTIVE DATES BRYDEN & SULLIVAN INS PO BOX 1497 SOUTH DENNIS MA 02000 NAME OF INSURANCE AGENT ADDRESS PHONE# o� M.B. HOME IMPROVEMENTS, INC. 53 CONGRESSIONAL DR o� _ YARMOUTHPORT MA 02675 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services a provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 002589 w20P,G16 TO BE POSTED BY EMPLOYER Office.of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massaphusetts 02116 Home Improvem�` t G6 ractor Registration Type: corporation oration 4r � ' M.B. HOME IMPROVEMENT, INCla' Registration: 180881 Expiration: 01/22/2019 53 Congressional Drny � µ Yarmouthport, MA 02675 Update Address and return card.. •--� Mark reason for change. SCA 1 to 20M OS/11 9 n Address ❑ Renewal ❑ Ernnlnvment ❑ Lost Card er�nzirrorru calf/r,o;C/Ii�irJofecl cutelld Office of Consumer Affairs business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corporation before the expiration date. If found return to: Ri�gwtrstlon Expirstlon Office of Consumer Affairs and Business Regulation 180881 01/22/2019 I 10 Park Plaza-Suite 5170 M.B.HOME IMPROUEMEN,T`�INC. Boston,MA 02118 Michael Bemstein� 1 ",'' i 53 CongressionahDr Yarmouthport, MA; Undersecretary i Not valid without signature ' I I r — 64 UPI _��� '�.�_�C�. ����#�..��_�'( '�~J-�Cf .ice?/��.1»'-.-:��._L�Sd.,�._..+ . �.V`_��.-� _✓!E k �.__:�,/.._.i.-_ Sao ' _moth ! 1 M -kLb J i2127/ ppTHEr Town of Barnstable *Permit# O Expires 6 months from issuertate + • Regulatory Services Fee (J a # i AIRNP.TIAi.Y. # - s Thomas F. Geiler,Director E Building Division 'P �jFj M T Tom Perry,CBO, Building Commissioner L E C 20 2011 200 Main Street, Hyannis,MA 02601 www.town:barnstable.ma.us '� k �ijyrEAR S Office: 508-862-403 8 Fax: 508-790-623 0 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Yalid without Red X-Press Imprint Map/parcel Number Property Address J t l �i ct C(4 j S pc C(L E9 Residential Value of Work 11 .3 J0.00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �Z,paw _t i r v Contractor's Name ��1F'i/U S �✓!��`/C/�G� Telephone Number_ Home Improvement Contractor License#(if applicable) S 31 q Construction Supervisor's License#(if applicable) o Li 10 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ® I have Worker's.Compensation.Insurance Insurance Company Name _ I`T��9'/)/%a //y y!�G✓� Workman's Comp..Policy# �c0ap4 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping,old shingles) All construction debris will be taken to. W A6� ❑Re-roof(not stripping. Going-over existing layers of roof) �-Re-side #of doors ❑ Replacement Windows/doors/shders, U-Value (maximum ,44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc, ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is' required. ,GNATURE: ,WPFILESIF0RMSIbm1dingpermit formsT_URESS.doC - - j —, ,, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d 600 Washington Street t Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): . Address: o 01161,Aj A ,1a e- 5 City/State/Zip: r�GG Phone.#: �O3��� ct- Are you an employer?C eck the appropriate box: Type of project(required):: L n I am a employer with _ 4. .I am a general contractor and 1 * have hired the sub=contractors 6. ❑New construction . . employees(full and/or part=time). • . 2:❑ I am a sole proprietor or partner, listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑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 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. o workers' co right of exemption per.MGL Y � mP• ill:❑Roof repairs § insurance required.]t c. 152, 1(4),and we have no . ❑ employees. [No workers' 13. Other POMP,insurance required.] *Any applicant that checks box#1 must also fill out the,section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an.additional sheet showing the name of the sub-contractors and state whether or not those entities have i 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: (/12,94L,Ce. / Policy#or Self-ins.Lic.#: tG - d "C>' ®G/� Expi/ation Date: ! l p2 Job Site.Address: City/State/Zip: �Ft/-4 r� �S C1 �0, 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 certifV under the pains•and penalties of perjury that the'information provide aboveris true and correct Si afore:` Datjd� t 7 Phone Official use only. Do.not write in.this area,to be completed by city or town official City or.Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.ElectricaI Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i u 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 orr 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 evidencd of compliance withthe 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. 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 whichmill 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 io 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 A.widents Office of InvestigatWas 600 Washington Street: Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 • www.mass.gov/dia THero,,� Town of Barnstable �. Regulatory Services &UWSTABLE y MASS. Thomas F.Geiler,Director �p 1639. �b TFo ' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnsta b l e.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner.Must Complete and Sign'This Section If Using A Builder as Owner of the subject property hereby authorize J 0S to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owmer Date l Print Name 1 If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION r Town of Barnstable o„ Regulatory Services BAMSPABM * Thomas F.Geiler,Director 1639. .�� Building Division rFD Mp'I 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: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state. zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The 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 requirements. `+ Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger`.will be required to comply with the State Building Code Section 127.0 Construction Control.. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor. Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt f eonara Insurance Agency BTS FAX 12/19/2011 2:48:47 PM PAGE 2/002 Fax Server Massachusetts Workers'Compensation Insurance Plan Acadia Insurance Company Administered by Berkley Risk Administrators Company,LLC PO Box 1100,Mpls,MN 55440-1100 222 S 9th St, Mpls,MN 55402 Acadia Insurance Phone(605)945-2144 Fax(866)215-8118 'Toll Free (800)634-4589 NCCI Carrier Code 33391 CERTIFICATE OF INSURANCE 1.The Insured: WWI Policy Number:WC-20-20-000092-04 Carlos Figueiroa Tax ID#: F 01-6723094 dba: C N F Remodeling 20 Captain Noyes Rd Policy Period: From:5M/2011 South Yarmouth,MA 02664 To:5/1/2012 Date of Mailing:12I19/2011 The Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not amend,extend or alter the coverage afforded by the Policy listed below. This is to certify thatthe Policy of Insurance described herein has 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 Policy described herein Is subject to all the terms,exclusions and conditions of such Policy. i fi 7 •: uutUull : i iynm .. I WI11N — _m•„niouiuu "' :'n:' . Rn6ur�y n1pm_Sunr.:n:.' ll7 il— mm uli nin n' Illi1l1li(II r coverage Part One State(s) Workers'Compensation Statutory MA Part Two Bodily Injury by Accident $500,000 each accident. Employers'Uability Bodily Injury by Disease $500,000 policy limit Bodily Injury by Disease $500,000 each employee. Should any of the above described policies be cancelled-before the expiration date thereof, notice will be delivered in accordance with the policy provisions. All Entitles/Insureds: Certificate Holder's Name and Address: Flguelroa Election Election Town of Barnstable category Stahis Name 200 Main Street Sole Proprietor Include CarlosFigueiroa Hyannis,MA 02601 Date issued: 12/t912011 Leonard Insurance Agency Inc W3 Main St 5 Osterville,MA 02655 r it Signature_ ;_.,r'— -BA 3140 License or registration valid:for mdividuI use.only L tiefore-the.esprration:.date: If found return toe I' Offi of Consumer Affa>is.and-Business Itegula ce io 10 Park Plaza Suite 5170 Boston,MA02I16: t i[ A,. Not valid without signature � �"� �am na ynB.siness S:g & er,Affairs CTOFt I` Office of Consum ;I. ENT CONT� Type` r � HOME IryIPROVEM . registration: 1537 32 pBA ,r ExpWPOt -�k812Q1 �i 3 MODELIt+I ` FIGUEIRO,a gain—,ems 1: CARLOSOYE.R�Rt�,�--� � � • . P. 20 CAPTAIN N Undersecretary . S YARMOIJTH MA'026Q' ti111,.'1(hn� Bo rrd of .Burl{Irn�, 1 rrT►»cyrt o1 constr Rel ulatirr Public S:rt(t� License:-CS action Supervisor Lic d Stand reds 104107 erase CARLO 20 CAP-r N N EIROA SOUTH YARMOpY ES Rp TH, MA 02664 _ Expiration: 812&2013 Try: ,1041.07 _ - Jf - "A TOWN;OF BARNSTABLE BUILDING PERMIT•APPLICATION 'y Map :, Parcel 10 4S A.11`i- y -Permit# Health Division en ''� /✓- Date Issued ILI 0- Conservation Division b 2 Fee .y 0 Tax Collector SEPTIC SYSTEM MUST Treasurer INSTALLED O N CCMPLIAS WITH TITLE 5 Planning Dept. '' EN IR�OWNMENTAL.CODE AND ' Date Definitive Plan,Approved by Planning Board' N REOULATICu S Historic-OKH Preservation/Hyannis Project Street AddressVillage Owner �S �' / � 7�r Address .Telephone • Permit Request Square feet: 1 st floor:existing proposed 2nd floor:existing proposed LG Total new Estimated Project Cost 43,Sty-> Zoning District Flood Plain Groundwater Overlay Construction Type ���� Lot Size Grandfathered: O Yes ❑ No*� If yes,attach supporting documentation. , Dwelling Type: Single Family DC Two-Family O Multi-Family(#units) Age of Existing Structure 2Z -)e i4eS ,Historic House: ❑Yes WNo On Old King's Highway: U Yes 21(No Basement Type: Full. ❑Crawl 0 Walkout ❑Other Basement Finished Area(sq.ft.) A)00C Basement Unfinished Area(sq.ft) Number of Baths: Full: existing Z new Half:existing new Number of Bedrooms: existing 3 new - Total Room Count(not including baths):existing �P _new First Floor Room Count S� Heat Type and Fuel:• 'Gas ❑Oil ❑ Electric ❑Other Central Air: - ❑Yes )(No Fireplaces: Existing / New — Existing wood/coal stove: ❑Yes �k1V0 Detached garage:❑existing ❑new size Pool:O existing ❑new 'size Barn:O existing ❑new size Attached garage: existing O new size Shed:U existing l]new size Other: Zoning Board of Appeals Authorization ❑ .Appeal# Recorded 0 Commercial O Yes' O No If yes,.site plan review# 'Current Use Proposed Use i ` BUILDER INFORMATION q Name PEAA-)I S (/A)CLlA Telephone Number Address LaC_ Y C✓�/u License# on Srl 9 Yti�/ S • �iS�SS. U'��� Home Improvement-Contractor-# 111 3 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FRO : HIS PROJECT WILL BE TAKEN TO _�i Aelee77Y SIGNATURE DATE /Q ` f' 7 —. •�' • FOR OFFICIAL USE ONLY - PERMIT NO. f �, � . s + ,�j, .. •• I � � `f `Y i y ,• .'' -� ; � `` � � �.- • DATE ISSUED' N Ft MAP/PARCEL NO. rll 'rr' _ ' • _ r• y `... r;' o ADDRESS . VILLAGE ..' s �' , •{ f ' OWNER DATE OF INSPECTION: FOUNDATION ' 7 �• _ F ', , FRAME r - INSULATION ._ . r t FIREPLACE ELECTRICAL: ROUGH) . _ FINAL - � • Yam" „p,, r ,. • ' R. . _ F? e t _ PLUMBING: ROUGH _ 9 FINAL .- ► -a 7 f ,` `. iL - �•_, �. GAS: _ ROUGH =r r' FINAL ' FINAL BUILDING tr, DATE CLOSED OUT ASSOCIATION PLAN NO. '- ' " The Commonwealth of Massachusetts -- Department of Industrial Accidents _= - 011lce allfirest/gatleos , . - 600 Washington Street `� I Boston,Mass. 02111 — Workers' Com,J ensation Insurance davit name: 'PC N t S V A-)3 Gl ,� �1 / - locatiow , 3t!,UC. iJ P y VIQl rl/C 14 7 4ti)�" S "-/1 to s ' city phone# M e--;Z-7r--6a ❑ I am a homeowner performing all work myself. . . I am a sole oprietor and have no one worku in ca achy ❑ I am an employer providing workers'compensation for my employees working on this job. N.:'ia� e%jjiji:i%}i'a 'ii'i:::`::: ::<:[%r`isi< i' ...` i» ?......................... >:» ` :i i'<<t ! :::::i s':" ':: r :' <:: ':'f> :` : ....:: r %':::3: COmnanv n m .Y:.Y:.::.:: tzildress. }:.;:.}:.}:.:. :,>;:::: :-: ; ;>::: ..::. .:.. shone#s '.><>:r'.: r<: < >::>? :>>'.>.> >:>: citwY:':: _. a. --- :::>::<:::<>::<:::<:;>;:>::::>::::>:::::.,.'-,:: :ltisuranceta;::.::.:::..... . 1. »: pl1 # ::::.;.:.. .. ti ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractots listed below who have . the following workers'compensation polices: compsn name :,:::::..:.;;:;::: v " ;.:...........:.:::.}:.}:.}}:.}::.}}:.}}:.:.:}Y::.:.::.}}:.;,:.; :.;:.Y:.:.}:.:.::::.}<::::.:::::.:.;':.>:.::.;:.}:..."'..::._::.::::::...-.:::::::::::::;::.<.::::::::::::::.}'::::::::.:::::::......;:;::::,.::.::::.:::::::.:::::.::.:<::,,::,.:.::.}:.;:.;;Y:.i;.;:.:.;:--....;;:<.i::;::Y;:.}:.;:.;}:;.};::.}:.}:.}:.}:.}:.}:' :.}::.}:.}:.}}:.}:;:; >` > .::::::.:.>'::::::::.:.:.................::.:::::•::::.::::::::::::..:::.::::::::::::::::.:::::::::.:,::::::.:...:........:::....:::......::::::: . ::...:--..:::..::::::::::::.:;:.:::::.:::::::::.::::::::::::::::::....:::.:::.:::.::..::.:...:.:::::::::::::::::::.::::::::::::::::::::::::::..:::.::::::::::::::.:::::.:_:::::.::::.:.:::::::::::::::::::::.::::::::.::.:::::. . ...................... ..... .........................................................................:...................:....:.:...............................................:...;<::.::::::::::::.:............................:........... ......:.:,:.:::. .:.;:. ;:.}::..;':::.::::::::::::::::::::::::::::::::::::::.::::::::::.......:"..:.::::::::.:.:::::.:.::.::..:.....:.::::.::::::::::::.:.::::::::::.:::::::;.;:: .......... .......................................:................ .:.........:........... .:.. . :...:.. ...:... ::.: :::. :::...::.. ::::::.;:.}.:.;:.;;:.}:.:.;:.;}:.};:.Y:.;:.Y:.}:.}:.}:Y:::;.}Y::..:::::::.:.:::::::.. .......... ....: :::• Y:; :;;: ::.:::::::::.. 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Failure to secure coverage as required under Section 2SA of MGL 152 can lead to the imposition of crbuinal penalties of a fine up to$1,500.00 and/or one years'imprisonment as wed as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby ce n �the pains and pe nn of perjury that the information provided above is Arw mid coned Signature — Date �U— � �/ — a Print name k) 1 S 1/J C a t l.) Phone#O F��`r_ 6 [ 6 official use only do not write in this area to be completed by city or town official • city or town* permit/license# ❑Building Department ❑Licensing Board ❑chedcif immediste response is required ❑selectmen's Office . ❑Health Department contact person: phone#; ... ❑Other L Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contrac: of hire, express or implied, oral or written. 4 . 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 c: 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'bouse 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renewai 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 Y, 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 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 <a.r?,r 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. 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 be used as a reference number. The affidavits may be mtrrniid 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 Office of Invesugations 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 . The Town of Barnstable xwm �$ Department of Seth Safetp and Environment Services : Building Division 367 Main Strew,Hyamis MA=01 Ralph Cra = OJr= 303.790-fim Budding Co=iuic= Far 3 s-790.4wa For aIIlce no only Permit no. AFFIDAVIT . SOME IMPROVEMBNT•CONTBACI.OR LAW SUPPLEMENT TO PERMIT APPLICA77ON uirzs that the "rgw=tnrctfonp operas** =Ovation. repair. modernisation. MGL e. 142A r+e4 demolition, or cottstructton of an addition to any pre-existing conversion. improvement, removal, units or to owner occupied building containing at least one but not more than abut dwelling structures which are ad aunt to such residence or building be done by registeret; matractozs. with i Cemin C=ptions.along with other regoiremeazs. : ' n �`^jam 5U� aa4C ly Type otWork Est.Cost `— nt: R( u fit! iV S' Address of wo Owner's Natae �� I✓ ��'�'� (,.'7ih'�7 ����" Date of Permit Application: t hereby certify that: Registration is not required for the following reason(s): Work mduded by law Job under S1.000. Building not ownerwccapied Gunter pulling own permit Notice is h G M OWN PERMIT OR DEAL NG WTI'H ONREGISI'E� OWNERSPUL CONTItAGZORS FOR TIoUR�M OR="At=FWDwMER M1qG 147A ACC=TO TgE,�RBTtRA SIGYID tJN Mt PW."=OF PER=Y t b u%by applY fora.permit as the agent of the owner. , �0 Q L-)CA) S i� S u� Date Contractor Name No. OR ��s C'��� -o6V Or, Owner's iinme' ' f-----____ _____________ ISSUE DATE (MM/DD/YY)== -C-ERTIF I C A T E OF INSURANCE I --- 0 1 01/09/98 - -------------------------------------------------------------------------------------------------------------------------------- PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, Mahoney & Wright - Yarmouth EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW OneAtlantic Ave. ------------------------------------------------------------------------ 1 S. Yarmouth, MA 02664 COMPANIES AFFORDING COVERAGE ----------------------------Y------- --- - -------------------------- (508) 398-6033 COMPANY Aetna Casualt & SuretyCompany ---------------------------------'.------------------------ LETTER A INSURED COMPANY Legion Insurance company LETTER B THOMAS OLSON COMPANY 51 Driftwood Lane LETTER C S. Yarmouth, MA 02664 COMPANY LETTER D COMPANY - LETTER E I- COVERAGES ______________________________________________________________________________________________________________________ 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 CONTACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ---------------------------------------------------------------------------------------------------------------------------------- ICO POLICY POLICY {LTRI TYPE OF INSURANCE I POLICY NUMBER I EFFECTIVE (EXPIRATION( LIMITS --DATE- --DATE---+- --------------- ----------------------------------------------- GENERAL LIABILITY GENERAL AGGREGATE $ 600,000 A 0024972953 10/04/97 10/04/98 PRODUCTS-COMP/OPS AGGREGATE $ 600 000 CX] COMMERCIAL GENERAL LIABILITY PERSONAL ADVERTISING INJURY z C ] CLAIMS MADE CX] OCCUR. EACH OCCURRENCE $ 300 000 C ] OWNER'S & CONTRACTOR'S PROT. FIRE DAMAGE (Any one fire) $ 300 000 I C ] MEDICAL EXPENSE(Any one person) $ 5,000 !-----------------------------------------------------------+---------------------+--------------------------------+--------------- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I$ C ] ANY AUTO ---------------------------- -------------- I ALL OWNED AUTOS BODILY INJURY C ] SCHEDULED AUTOS (Per person) I$ C ] HIRED AUTOS -------------------------------- --------------- E ] NON-OWNED AUTOS BODILY INJURY C ] GARAGE LIABILITY (Per accident) I$ C ] - ------------------------------- -------------- PROPERTY DAMAGE I$ ---+-------------------------------- ----------------------+----------+----------+--------------------------------+--------------- XCESS LIABILITY EACH ICE]lUmbreLa Otherl Than oUmbrella Form I I I I AGGREGATERENCE I$ ---+--------------------------------+----------------------+----------+----------+--------------------------------+--------------- B WORKER'S COMPENSATION WCl 0116520 09/23/97 09/23/98 STATUTORY LIMITS AND EACH ACCIDENT $ 100 000 f EMPLOYERS' LIABILITY DISEASE - POLICY LIMIT $ 500 000 DISEASE - EACH EMPLOYEE100"Oor ---+--------------------------------+----------------------+----------+----------+----------------------------------- ------------ j OTHER i A BUSINESS PERSONAL PROPERTY 006MP 0024972953TWF 10/04/97 10/04/98 $ 1,000. 90%,ACV CONTENTS SPECIAL INCL. THEFT $ 250. DEDUCTIBLE ------------ ---------------- ---------------------------------------------- DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS } I i = CERTIFICATE HOLDER ______________________________________ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES ED BEFORE THE TOWN OF BARNSTABLE EXPIRATION DATE THEREOF, THE ISSUI M Y ILL VOR TO ' MAIL 10 DAYS WRITTEN NOTICE TO T CERTI CA E HOLDER NAMED TO THE BLDG DEPT LEFT, BUT FAILURE TO MAIL SUCH N ICE S IMPOSE NO OBLIGAT ON OR LIABILITY OF ANY KIND UPON THE COMP NY AGENTS OF REPRESENT IVES. --------------------------- ------ - -------- --- --------- ------- AUTHORIZED REPRESENTATIVE call �//l q �_ v � � has �,� ���/' � ��.� � rrz� ,�,� ��� �� ���� * M.M.C. . A P P R A IrS A.L V I, S I 0 N �. . - -<-•,��gPYRIGHT. 1993 .. - Assessed Parcel Value (L90)_ !r's-Name- - Location .RS, MARY C & 1676 NEWTON RD ;SON, RALPH , 1682 NEWTON RD ICHETTE, ALAN R`&"SUSAN- 1690-NEWTON RD SAN DAVID `. 1698 NEWTON RD CC 1ONWEALT-H E fECTRIC NEWTOWN RD COT ZZI. THOMAS TRS & 4591 ROUTE 28 COTU Tilt- C1I111I11 Un weaflh of 1 histi acfl usclLS Dc purf"Ie"t of Industrial Acridents OfficP�/layestlgativns 600 JI'aski»r;tulr Street .�- `.�'�• � �:. Bustnlr.Alua:r. U3111 1 V Workcrs' ComPcnsation Insurnncc At davit i iic nrintnrm�ion• _ _PI lse wI'RINT le-01V - r1 • �r.bu U I'Vu 19L,n Inc-,inn /� /1c C Cil-v ok l//L.^� �`�T J v rihonc I am a homeowner performing all work myself. Iwam a sole proprietor and have no one working in any capacity I am an enipiover providing^workers* compensation for my empiovees working on this job. rnmrtnn�- n•tmc•• arirlrr�c- cite nitnne 0• J in�nr^nrr •-n nniicv>Y �� � m�Jo Yroorte:or. btneral contracro , or homeowner(circle arrej and have hired the contractors listed beio�� +r.c /(tthe a rs �� m_ rvor>;e. campensano2n police_. /,��.� /N/ S �(e-,��' ,yo �sa�l o C�aal rcX ff 1 cmmr:tnv n-tmr• 9 ti if rr-- ctt`" nllnnC�• inI 77 nniiry zf nr-�rr rn _ cmm��n�' �nmr• nri(Irr•� rirv- nitnnc#• in-trnnrc rn AMch sdditio_nai sheet if nectssan- _ —r - -�'� _:::: " �"'�•'' -- = �• F:uiurc to secure ctwcrat:e as required u Ucr tecnon-cA of i11GL 152 can lead to the imposition of enmtnal penaities of a tine up to SI.500.UU inuror unc cars' imprt>rtnment :1. r%cll:ts cit ii pCnai(ics in the form of a STOP NVORK ORDER rand a fine of S100.00 a da%.against me. 1 understand th.t cop) of thin .surtcincur mn% be furwirded in the Olrce of Investigations of the DL1 for coverage verification. /do irercnr c•mir furrier r/1e prritrs nit '�crraltics njperjun•r/tat 1/te information provided above is trur and correct. Oatc Q Q Phone ft�• otTiciai use nnh• do not s�•ritc iri this arr:r to be complctcti by cir}•or torn otticiai E' gin nr tntt n: permit/license d r'Ttluildin,Department ClLicensing Board �Scicctmcn's Uffrcr r _ :heel: if imrncdiatc rrspunsc is rcyuircd r' : rtleaith Drpartmcnt r r costa:t ncrsnn: phone ii• —Other_. ` Information and Instructiclas Massachuscn.s General Laws cilapicr 152 section 25 requires all employers to provide workers cc1mPcll5:ltioll elllnim•ccs. ,is yuotcd titlm the "law-. an e•»I•pfi ree is defined as ever},person in the sen-ice 01 an-other undc- -. - col;tracl of Hire, express or implied. oral or written. . ._ ' .r , t� 1 � -� �. ���.. a •, �i� . An emph)rer is defined is an iiidividtiaf. partnership:association. corporation or other legal entity, or any 1%vo or tale foreuoinu in a joint enterprise.a1h'd'incIudin-g*.thc le;_al representatives of a,deccascd einplovcr. or rccciver or inistee of an individual , partnership. association-or other'iegallemity, employing einpfgvecs. Ho%ve-.- owiler of a divellin__ llotlse having not morc�than'three apartments and whb resides therein. or the occupant of the d\\cilin�, house of another wlio employs persons to do maintenance ,construction or repair wort: on such divelIit:; or oil the __,rounds or building appurtenant thereto shall not because of such employment be deemed to be an etr.c: MGL cil:ipicr 152 scci-oil _5 also states that ei-ery state or local licensing ngency shall withhold the issuance o , 211•al of:I license or hermit to operate a business or to construct buildings in the commonivealtil far any icmit who lins not produced acceptable evidence of compliance with the insurance coverage required. Aclu..iollnily. llcitiler the commonwealth nor any of its political subdivisions shall enter into any contraCt for the per;�nll;::ce of public work ulliil acceptable evidence of compliance with the insurance requirements of this ci.cc: he :: prescated to the contracting authority. f!.cse +ill in the worl:crs' compensation affidavit completely, by checking the box that applies to your situation z: succivin_ _oirspany names. address and phone numbers as all affidavits may be submitted to the Deparimcsa of nc trial .accidents for confirmation of insurance coy eragP. Also be sure to sign and date the affdavit. T1te iaV it Jlouid he returiled to the cin• or town that the application for the permit or license is being requested. r :'lc Decamnent of"Industrial ,-accidents. Should you have any questions regarding the "law" or if you are recc: o ?ctcin c workers' cornpcnsation p011Cti. please cail the Department at the number listed belmm. Cin• or Fw ns Flee_ -le --urc :hat tine affildavit is complete and printed legibly. The Department has provided a space at the borer the :`azvit for you to fill out in the event the Office of Investigations has to contact you re_arding the applicant. be _ : to fill in the permit/license slumber wilich will be used as a reference number. The affidavits may be return -:le Dc:Cartment by mail or FAX unless other arrangements have been made. The Dfr;ce of Invesilazzlons would like to thank you in advance for you cooperation and should you have any quest please do 11ot hesitate ro•_ia-e us a call. The Deparrnent's address. telephone and fax number. The CommomveaIth Of Massachusetts tt 'Department of Industrial Accidents Office ei Investigations } 600 Washington Street Boston, Ma. 02111 fax R: (61 i7 727-7,749 nit0nc =. i - 900 c�:r. 106. '011 or _-:- PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling & 0' Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc . HOLDER. THIS .CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St . PO BOX 1�990 COMPANIES AFFORDING COVERAGE Hyannis, MA 02601 COMPANY AU.S .F.& G. INSURED COMPANY Dennis Vinsun B 32 Blue Jay Drive Hyannis, MA 02601 COMPANY C COMPANY D COVE...A4S THIS IS TO CERTIFY THAT.THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY BFS00000066589 08/13/97 08/13/98 GENERAL AGGREGATE $1 000 000 IWNXPD MERCIAL GENERAL LIABILITYPRODUCTS-COMP/OP AGG$1 0 O O 0 0 0 CLAIMS MADE N OCCUR PERSONAL&ADV INJURY $5 0 O 0 0 0 ER'S&CONTRACTOR'S PRO EACH OCCURRENCE $50O 000 Ded:2 5 0 FIRE DAMAGE(Any one fire)$5 O 0 0 0 ME D EXP(Any one person) $10 0 0 0 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $. ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY EACHACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLAFORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND STATUTORY LIMITS. EMPLOYERS'LIABILITY EACHACCIDENT $ THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE DISEASE-POLICY LIMIT $ OFFICERSARE: EXCL DISEASE-EACH EMPLOYEE,$ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Operations performed by the named insured as provided for by the terms and conditions in the policy GERTIFICATE HOLDER ':: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Barnstable EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL South St . : 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Hyannis, MA , 02601 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES. AUTHORIZEELRFES SENTATI4E s ,cs .•. I►CORD 2 S f 193)1 a# 1 ......:. 114 75 d .. DAS ACOIRIE$ (3RPOFIA7IQN tss3 _ - :., h9ency,s Inc, o� The Town ®f Barnstable � e artment of Health Safety and Environmental Services D Building Division 367 Main ShtCt,Hyannis MA 02601 Ralph Crosse.^ Oflice: 508-790-6227 Building Comr-, Fax: 508,90-6Z30 For office use only Permit no. Date AFFIDAVIT HOME zffROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the reconstruction, alterations, renovation, p Rair, modernintion, conversion, improvement, removal, demolition,et one but aot�moreon f than fouraddition dwelling units pre-existing to owner occupied building containing at structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements ��5 ,� ��� Type of Work: ���1 � mot.costql ' Address of Work: Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following renson(s): Work excluded by law Job under SI,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWN PERMIT OR DEALING WITH UNREGTS'TER OWNERS PULLING THEiR F.D CONTRACTORS FOR APPLICABLE SOME IINIPROV'E:MF.NT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL r- 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent waer. Az� el F? 77 Date Contractor flame Registranon No. I (jQ -ll^l{ylLj�jy�,/r[ ^�✓%9�c2i1E49�C7 DEPARTMENT OF PUBLIC SAFETY CONSiJRUC1ION SUPERVISOR LICENSE ' I. -Nartier�f Expires: ed_Fo: 00 '. �, OEN VINSUN' ilk d DRIVE "ANNIS l' 0o I I j i ( M t I y r.. I • fl Ie ti I M � jli 1 I { i _ b� I h y IT I I vi ;r4 y_ ----------- ' ; I6 16 i li h--0 9 T IVI Li c i /r4r ii �%• __ goy �, o j i I I I t STANDARD LEGEND / \ me nat�8 Sym6ebwll aiVmmaaop GOLF COURSE FAIRWAY OEOINNTHSias / ," \ � EOfE0F 6RU511 ' ` \ KWI ORCHWORNURSER! I �p '3 MNIFEROUSTREES NIAP - ` C MARSHAREA 1� R ' 50. .� WA OFWARR 233 -- OIRF ROAD l� DWES 1�—PARAXG LOT iff---BAYED ROAD // ,v - WH/TRAIL \ \ 1_1 PROPERIYUNES AYV N 4 4 - - \ - \ --- 2 FOOT CBNTOUR UNE 0 IO FOOT(ONiOUR UNE \ x, SPOT ELEVATION STONEWALL 5 6 ---f FENCE - RETMNING WALL ' / \ RMIROADTum I / STONEAHFY @ SIMMONS POOL MAr PORCH/DECK 4• BOI 1 ONBS/SRUMRES µ+µ OOO/PIER/JETTY M AS56SORSMAPBOINDARP " 1 A WNE Al IMAGOES ( I - 0 POST O� NAANW SIGN ® siomom 0 POE ° TONER 1191T o MEIN R '- - - - - - - - - - - 1 � - SITE MAP — / T.O.B.GEOGRAPHIC INFORMATION SYSTEMS UNIT SCALE:in feet 0 30 60 s - - - - - -- - - 1 INCH=60 FEET` " 1 - MOIF:INf PAM80N6ARE ON,AN NUTIRCRP65ENIANONS OF - RIOPfRIY POUImNOS.HOTIR MOfiNlf IOTAHONS aJG.9-9/ R - 1�R YN101H1®WIBIHONIWINDRImi0. - INNOMmpWm I'lP.NWPNRARAI�NIMIRMIM X0070FAN MONNIWS19//. 'MNWNNHI•�IR.1®NCWRANNNOBIHN(nB91 - - SOEIIN0�19. h:ltemp\m233.dgn Oct. 19,19% 13:35:19 �f 4, Tennis Tinsun Esq. ' T1 esi ner - 'Builder 32 blue aay lTrive -Tyannis,JM 02601 77S-6989 Sax 77S-0683 , r i V J f V ��t tih Engineering Vept. (3rd floor) Map Parcel 'yS Permit# 1 a House# 2,91 6 'hued Board of Health(3rd floor)(8:15 -9:30/•1:00-4:30) R 9 1N� SysT� d. ®WSPU Conservation Office(4th floor)(8:30- 9:30/ 1:00-2:00) - VVIT {TITL AP,{�� Pl coo .) D and 19 _ BARN3TARLE.SS Fo� MA T' F B ' OWN O ARNSTABLE ' Building Permit Application Project Street Address 3 9 flu kll,k)S4)e /C /�<}c� Village`; ��'i(>j /�U/L�� f°' SS 11LISSTTs Owner A 45>Ae 4r �!�6�, !C, 7�0 / Address Telephone 3Cc,2—a403 .� . _Permit Request J First Floor square feet Second Floor A-)0kk— square feet Construction Type dy VZE.,2/l) Estimated Project Cost $ Zoning District Flood Flood Plain Water Protection Lot Size `tom�f, 4 qo -f' Grandfathered ❑'Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure ,C Historic House ❑Yes J�No On Old King's Highway ❑Yes k"N'o Basement Type: XFull ❑Crawl Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. 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 114 es ❑No Fireplaces:Existing l New Existing wood/coal stove Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) A30 14 Attached(size) 20 x ZZ ❑Barn(size) AJ6 ❑None ❑Shed(size) tiO ❑Other(size) ayd d Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes gNo If yes, site plan review# - Current Use Proposed Use Builder Information Name (DJyA lS �/(�SOA) Telephone Number Address V/C/o-� License# (1-1"16 ����iy�l S, /�`S S • C 1;01 Home Improvement Contractor# 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 DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY + `i• e �f 6' 1. �,y.. - _ . j� �fi+ . . PERMIT NO. .1.: ; —DATE ISSUED• MAP/PARCEL NO. ADDRESS +' —y VILLAGE r OWNER a DATE OF•INSPECTION: FOUNDATION �2I'Z-`L�4-7 jp,. FRAMEci INSULATION �.i !�- C`�' FIREPLACE ELECTRICAL:NY ROUGH FINAL - f PLUMBING: r ROUGH FINALr t� �� -. - :. - . , . Jet• . GAS: �.,. ROUGH FINAL- FINAL BUILDING. 5 III DATE CLOSED OUT ASSOCIATIONTLAN NO. 1 ex..':J`Sy1.:+tY.,'F'*Ny"'*,tY+:.+.,as:-s.�.-,,-+e:..M..:.T,.,....r;,{�ee,..1i�-�y'1.7My�+Ae�tr lv+. ..sir-rso-'r�"yr:g,.�gi^-a'l'-.,- � _ ,A:,c'--..-:.=';rr:,ri�• r.^`yR„'7+eArw•'.;y.eir.,.sY^i;�e` ?,t u^+c'w"^ ;e+tr: ti,-,.a,e. Y Al l Assessor's office(1st Floor): �- jl 1. -Assessor's map and lot number �33 Ioy'✓- o k, �pf YHE to` 1 V 'Board of Health(3rd floor):^,Sewage Permit number Engineering Department(3rd floor): sAHlST&DU .f 4riiaa House number • Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-910 A.M.and 1:00-2:00 P.M.only a TOWN OF BARNSTABLE BUIIDING INSPECTOR '"'� 1 /1 /� f APPLICATION FOR PERMIT TO / �C G'(/©Uz) :i .c / t r TYPE OF CONSTRUCTION TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location , Proposed Use Zoning District Fire District Name of Owner(�/��`� � f �/��-�s� Address z `/ Name of Builder c'- /�i//i// '�Gt�G✓/G61 Addres �C �� '�' i'"�'/ GL/. zV Name of Architect Address r Number of Rooms ''' Foundation Exterior Roofing Floors Interior Heating Plumbing y Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions Fee t � � � F 2 L �� � � OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction Name h Construction Supervisor's License v� �r i TRATT, GARY A=233-045 No 33885 Permit For Raze Wood Deck Frame Location 391 Huckins Neck Road Centerville Owner Gary Tratt Type of Construction Frame Plot Lot Permit Granted July 30, 19 90 Date of Inspection 19 Date Completed 19 PERMIT COMPLETED 1/1/ pdsessor's office(1st.Floor): i Assessor's map and lot number "' o MI5 QI�_ Poi TN E Ioard of Health(3rd.floor): d� ewage Permit number Z DAS39TSDLL i Engineering Department(3rd floor): 3�/ �Jf NAB& House number °0 t639• Definitive Plan Approved by,Planning Board 19 �Fo MAY APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BU ING INSPECTOR APPLICATION FOR PERMIT TO G�/©d� r TYPE OF CONSTRUCTION 2 - 26 19 � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to he folio information: �.o Location Proposed Use Zoning District Fire District /-'., Name of Owner Address Name of Builder �� Address 4v Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing O PP Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions Fee 7(3Q 0 FNN)s V `1 �j s U rJ 2 L �� .s E� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barn (able regarding the above construction Name � lL Construction Supervisor's License o v 47 1 TRAIT, GARY el; 1. } No '33885 Permit For Raze Wood Deck ' Frame Location 391 Huckins Neck "Roar3 Centerville Owner Gary Tratt S Type of Construction Frame Plot, Lot Permit Granted July 30 J 19 9 0' IN Date of Inspection- 19 Date Completed 19 1 1 i ' If Assessor's map and lot number ........C72:�? ........ ... C-1 0 THE Sewage Permit number .................................. 339RNSTADLEI House number ...................... ................................... .............. kNAS& Op 039- J TOWN OF ' RARNSTABLE Ile BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... ........ ... ........ ...... .... ......... ............... ................ ..yr TYPE OF C .......... CONSTRUCTION ..... ................................................................... ..... ........ ......... .......19....6.31 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby oppl,i,e's,for a, permit according o 9 o thq-f wing infor ation: ;J0 Location .... ...... ..... ....... ...................................................... .................................. ... K( ...... ProposedUse ..... .... ...... . .......... .............................. .................................................. Zoning' District ...... ..........................................Fire District ............. ...................... .....Address ................................ ....... Na�ne of-Owne ................................. dress .4�............... ....... ... ..Name of Builder ...... .... ..".Address'7', ... ....�z...... Name of Architect .................... .............................................Address c ..................... ...... ............................... ...................... .. .............................../.............. Numberof Rooms .........................Foundation ............................................................................. Exterior ....... ............. .................Roofing ...... ...... Interior ...... z: Floors ...... ............................................... ........... ...... /......... .................. ...... ....................... 9 r6rr� Heatin ing ........... . ................ Fireplace ............ C..............................................Approximate. Cost ..... ........ --7 �Definitive Plan Approved by Planning Board --------------------------------19--------- Arecfj:5�-.X........ Diagram of Lot and Building with Dimensions ree 7 .. . ... ....... SUBJECT TO APPROVAL OF BOARD OF HEALTH 71/ J. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS. I hereby agree to conform to all the Rules and Regulations of t —Town of Barnstable r/egar Kg�the above construction. Name .............. . . . ...... .................................................. QjConstruction Supervisor's License 019.............. TRATT, 99ORgE E. DR. A=233-45 ild Solarium No ....�8160 for ....................................... Permit Single Family Dwelling .................................. i�WWs VX69 391 Road Location. ................................................................ Centerville ............................................................................... Dr. George E. Tratt Owner. .................................................................. Type of Construction ...............Frame........................... .............................................................................. Plot ............................ Lot ................................ July 8, 85 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed .......................................19 Assessor's moo and lot `6umboer ............... ...... THE k SEPTIC SYSTEM MUST BE C WITH Sewage Permit number ................... ................ INSTALLEDH TITLES IN COMPLIAN 33AUSTAXE, MAG& House number ............... ........ ......... ..................................... ENVIRONMENTAL CODE AND V 1639. TOWN REGU 11 MiNY :TOWN OF BARNSTABjun BUILDING INSPECTO APPLICATION FOR PERMIT . ........... :.0p. ..... .... ......... .... ................. ................TO TYPE OF CONSTRUCTION .......... ....................................................***—*,—**... ........ ......... .. . .... .. ....... ...19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby ap P for� permit accordin/go the of wing infor ation: Location ..... . .... .............................. ...... /. . ................. .. .......... ..................................... ................................................Proposed Use ..... . ..... ......<��...... . .......... Zoning District ............... ........j..................... ................Fire District ...................... Nameof Owne .... . ....... .... ........... .................Address ............................................................... .. .. ............. Name of Builder ... .... ........ ......... .. .. ...........Ad d ress 154. ]�L...... .. .. ...... ............... ... ... ..... Ile, Nameof Architect ..................................................................Address .................... ........ .............................. ...................... Number of Rooms ... .........................................Foundation ..... ............................................................. ell Ir Exlerior ....... ...... .................Roofing ...... ........4�.......... . ...........— .......... . Floors .......Z� .............................. Interior ........ ...... .......... Heating ..�6 . .......... .... ...... ..... .............. ................ ............................ ... .. mg ....... . Iz�Fireplace ............ .........................:.................Approximate. Cost ..... .................... ........... ... Definitive Plan Approved by Planning Board ---------------------------------19-------- - Arecj/,Z.4........ ....... . ....... Diagram of Lot and Building with Dimensions ............ SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of t 'n of Barnstable regar g the above construction. Name ... ..... .................................................. 69 o v Construction Supervisor's License .............. { TRATT, GPEORCt E. DR. "L 28160 Build Solarium 4 No .....:.........:. Permit for r Single Family Dwelling . .......... .................... ..................... 391 Road „i Location ................................................................ Centerville Dr.....GARY E....Tratt.................... Owner ............................................ .................... Type of Construction .......Frame ...............................:...............j................................ � Plot ............................ Lot................................. qxd Permit GranJul ..ed ... 8� ..........Y...,... ....... 19 . 85 k ` Date of Inspection.....................................19 . Date Completed �/�.�..................���� 19 `= , a l iTl un z tr r� - .mac �k „-� A.w- .._.,.'. ".... 'r � _ ._..� �. -. �. ,0.n� ••-•�'�s�` -,.-.j.,,r-. .. . �.v-nf�y`Tcw/o.�' ”" "`�'_r .'-i' ,r«..-.... , �-v 'Assessor's map and lot number a ... � . ^..� lr 77. .... :} - 7 2 S� _ Sewage:Permit number ................................. . 4 TOWN- OF BA_ RNSTABLE ��fTHE TO Ii BAHBSTADLL r, �NASL6 9 BUILDING INSPECTOR ti •E,p Mix , APPLICATION FOR. PERMIT TO .:..... ....... ................ .... .................................................. TYPE OF CONSTRUCTION............ ( � ,/�S() ...... .�..�' ......�� 9./� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...........................................................Y....................................... ................................................................... Proposed Use �`cC/K�� C lC�1C ( / ...... .......... ..... .................................................. ... . ZoningDistrict .............. .........................`..........................Fire District ....,.......+(:.:..............,......:......,......... ....:.::......,. Name of Owner/-... LG'7l '�cZ.................Address .........17!� � /��,;, C�11� /,/C :...... _ ................ ..... ......... .. Name of Builder ... �G�!C!l/ /...1,../G1�,11�. .5..............Address � l/� c� G`„�/. ��z.....1 .C..... ................... ../�..//.:. .... . Nameof Architect ................................... ............................Address ............................... ............................................ Number of Rooms ... l%' :. ........................................Foundation ....�✓��`lG. fCr Exterior C <</ ..... ...! . .. : � .................. . Floors A )CC�LvI-- �Q./(t t�Y/r.(- ll��e....e. .......�� � ..../vGrl,,,•..................................../• \ .................. ........... g / /'-* `.. .... ( li....'.��/ „�%�ir�ll /`�Z'I/•• �r�L-7�1%/ �f CMG Heatin , Plumbing .:.........:...... ... . .... ......................... Fireplace ...�'Tl ......................... ......................................Approximate Cost .......................................- i�.:. Definitive Plan Approved by Planning Board _______________________________19________a Area .. � � h'`j.. Diagram of Lot and Building with Dimensions A ;#2S� Fee SUBJECT TO APPROVAL OF BOARD-.OF HEALTH ao. i -71 3` 4- I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 1/o ,yt�./.: .......................� . ......... Name .......... �.�.: , Tratt^ G. E. A=233~45 � l9�56 l l�2 a�mr� -No ---.—.... Permit for ---.-------.�— . . sin —� l �a���� dwelling � ----- \------..------------. ' ` Huckins Neck Road Location— ---^'--------^--------' . . � . ........................Ceotervlll.e.............................. Owner .G. E . � Type of . . ^ ' � plot ................. at)...............#45.......... � Permit77 . Grantedne 1 � � 'Date-of Inspection\_.......... .........19 � . Don, Co "p...d ' PERMIT REFUSED ' � g .` .— ---�`��'� -------. ^ .......................................................... ' ........................................ —.—.--..,---. '^ � /' .. ............. J ' ~^~------'----^^—'---^~------^ � Approved � . ' . .............................................. lQ ' -------------'----^'`---^'---' � � ----'-------------------^^^— � � ' | Assessor's mcip and lot`numb r ` SEPTIC SYSTEM MUST BE � -��� • � Sewage:Permit number :.........................................: INSTALLED I............... WITH N :COMPLIANCE S ARTICLE II STATE TOWN, , O d_ F ARN A Z B8$H9TSDLE, • i I � - R `IL�I �G = INSPECTOR pp,e�s639• 'E 0 MPY p :: t•t, f APPLICATION FOR PERMIT .TO ........ ... ................................................................... TYPE OF CONSTRUCTION �.�// /. ...............................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for er/i according to-the follo ' infor atio c Location 1....... . . ProposedUse ....... ....................G . .G ......`„� ,``.,:;...................... .................. .......... �� C . Zoning District . ,.. ..................Fire Districtgo;�2, ... .. . ... � ... .. . Name of Owner ..... ... ......... . . .:. -�..� .......:..................Address .. .... .. ........ .. ` .. y(...G...... .... .�:� .. .............. .... .. ... mod` Name of Builder ... . ..�r�.�5�7.... ....G.�..�..............Address ..../ . .. r 6L c �F. Nameof Architect ..................................................................Address. ................................ ........................... ....................... Number of Rooms ...Cry.. ..:.�!..............I....................... ....Foundation G.......a �W— it:C.......... 40 Exierior .:.. .. . .......... ........... :.X..... .......... . fing ...... .... .......L .L.� /� ........................... ... . Floors ... v ' "..........Interior ....... ...!.Q Ld .......CSC Heating ..... .. .. ... . ........f/ ......... ...... ..................Plumbing Y ". . .. . ..�:..�.J.. ��• Fireplace ...W.................................................................Approximate Cost ..... .,f . ....... .......... Definitive Plan Approved by Planning Board ________________________________19--------. Area ..00 , 7 Diagram of Lot and Building with Dimensions 1•�•Q�� . 1^ Fee ........... .... ................. SUBJECT TO AP AL O BO HEALTH '1. �9� C., �� �'"1 b I hereby agree to conform to all the .Rules and R gu ations of Town of Barnstable r garding the above construction. Name ......�.�.. . ........................ - Tnatt°_G, E. ' ' - lNo -��Z��- pern�nfor --..l-1/2 story -�.-- ....................... w �--..- -.=-----. ^ � uckins ���� �mm� ----._ ---.-.-_-----~--.-----~ - ' . �lm ---------.. . ,=.:=- ......................... Owner ...............G°-8L.. .�________` , Type-71 of Construction ---.f�j��P.------.. . ---.�-..-.---- .-. ................. - . ---.--- ,v . , - Pkt -.~---.�-�--. �t ---..�45----.. . ^ . . ° 77 Permit Granted ° I r ' ' . Dote of Inspection J........ 19 '�Dota Completedo| `��,���-_`l� ^ , ~~ ` . ` / ^ ' PERMIT REFUSED ^ ................................................................ lQ ` ~ ,�...--..-....-.~-------.~-.-..---.. � --'.-...�.....':.�.-----......-..--.-.�' - � . . ~ . . '-~---^'`-----^~^^^'—^'-~^'--'''-'r'' . ,_..'_..�,`_.__,___.__^,,,,_ .____�' _ ^ ' . -'' ' Approve6 _--------------. lg ' ..�-------------......^-.~.-~---' _--------- ................................................. ' ^ . . t ' r l� I MAP—Y Z �Il ju Box 26� / AIR�,�b �,3 " 0� /ood G.4 L•io i b' ` 901 S 44.o ° ro Cro Z-11ACaiNG y81si2' tr /DOD GAL. SEPT/C T4NK j .9 r 58 gD r JA �e CERTIFIED PLOT PLAN - y UCK//�/,5' NECK R� CE/VT�/�YILLE NEW 'CONSTRUCTION ONLY TOP OF FOUNDATION IS FEET IN ABOVE LOW POINT OF ADJACENT SSABII,\, STAS.L� .\ _.�d S4 ` ROAD. l SCALE; /�N - 60frDATE : MAY 27,1977 ELOREDGE ENGINEER/NG CO.lNG I CERTIFY THAT THE owfZL//VG CLIENT G.E 7x-,urr EMST SHOWN ON THIS PLAN IS LOCATED RE ERER D REGISTERED 76033 CIVIL I LAND JOB N0. ON THE GROUND AS INDICATED AND ENGINEER SURVEYOR DR. BY: A,A.111• CONFORMS TO THE ZONING LAWS OF BARNSTABLE , MASS. 33 NO. MAIN ST 71,2 MAIN ST. CH' BY: 7 .A 8 SO. YARMOUTH, MASS. HYANNIS, MASS. SHEET OF Z DATE REG, LAND SURVEYO ! a 20 FT. MIN. IO'FT. MIN. CONCRETE 411 PVC PIPE CLEAN SAND Elev•= 1O0" MIN PITCH - COVERS 1/811 PER FT CONCRETE COVER A 10 .. ..A , 1011 ".. • _ , LIQUID LEVEL 4";CA ST LAYER n OF I/811- 3/8�� Fill PIPE . . . . . , , . MIN0 off, PITCH-- SEPTIC TANK DIST. ° ° ' ` � • • • • off1/4 o WASHED STONE p ,. ,Y FtR FT BOX ° ' , • • EFFECTIVE' ' ^ • 3/41- 1 1/211 ,4 ��'. .: , t ' • DEPTH • ' ' ' - WASHED STONE �: .• • " ' ' • 0 ' 0 0 PRECAST SEEPAGE ° 1 • , ° ° PIT OR EQUIV. INVERT ELEVATIONS I-- 6 FT DIA. 10 FT. DIA. �C (SEEy TABULATION) INVERT AT BUILDING 9�•0 FT. INLET SEPTIC TANK 9 6.8 FT. GROUND WATER TABLE OUTLET SEPTIC TANK 9 6.6 FT. SECTION OF INLET DISTRIBUTION BOX 96 5 FT SEWAGE DISPOSAL SYSTEM ��;„ET DISTRIBUTION BOX 96.3 FT. SCALE 1/4"= l O id—INLET p SEEPAGE PIT 6•0 FT TABULATIONk DIMENSION A 3 FT. DESIGN CRITERIA DIMENSION B 6 FT.. NUMBER OF BEDROOMS 3 DIMENSION C 4 FT. GARBAGE DISPOSAL UNIT —1_ TOTAL ESTIMATED FLOW 3 00 GAL./DAY SOIL LOG SOIL TEST ELEVATION �I�N� l8, 19-7r NUMBER OF SEEPAGE PITS DATE OF SOIL TEST - SIDE LEACHING PER PIT 188 SQ. FT. a LOAM RESULTS WITNESSED BYgf/3- + n BOTTOM LEACHING PER PIT -78 SQ. FT. 18' sUa soil PERCOLATION RATE 2 MINf" 7 TOTAL LEACHING AREA 266 SQ. FT RESERVE • LEACHING AREA 266 SQ. FT. /`1N Of iy�s '?73- * a 5' 5AND Ca2AJEl. of M,�ss- ,�`��' sq�, ' •a* ..--....._..,.,s`,., HUCKI NS NECK RD. CC.NTERV 1LLE R08ERT yu� OBERTl Rr3RUCE P. �' ELDREDGE " ' $ BLINIKIs �, 3 ` t ''` 3' SAND wtrN sToivEs ELDREDGE ENGINEER•1NG CO. � A No.22is2�0 �F 33 NO. MAIN ST.'- .Ti,,MAIN ST w 4 c'8T E ��oQ No C,goo P uJ G 2 SO YARMOUTH MASS.'..: HYAW4 " ' 'I AS 4 � �f'r . �A N� SURv } � T.1. ���..°�` 7. JOB NO. 7G033 SHEET 2 OF 2 Dennis Vasunsq. r �,v 32 Blue 5ay Drive Hyannis, Ma 02601 I U v LT<I-� z izi Ole ,ZOO �C1G�Tic�t/,4� -cOr,r7t,� Dennis Vinsun Esq. 32 Blue .lay eve Hjanniss Ufa 02601 �"fU��2��`�,_ _�r-ASS• i - i 12,,z t, 1 ' 1 �tN r G J � , u LIM { i I L� i 11 I I I i i d - 4DT N Z n I BEA LOCUS N RS POND LOCUS MAP SCALE I"= 2000' ZONING DISTRICT RD-I I I I I I B.R.Bd. (fnd ) o. 0 Pain Macy 3 1 ' , 4 r-4 9 0 } S. F � BR End (fnd ) / O g S-7 / S 840 54'40 W 88 5 5' �S I40 50 30"E + ,, 15.00 G �" Q I B R Bd (fnd) certify tha' this plan hay been prepared ir; conformity. with the rules and reguiat ions ,�J the Registers of Deeds of the Common- vrea,th r)f klassachusetts Date Registered Land Surveyor PLAN OF LAND CENTERVILLE g A RN STABLE MASS. hereby certify that the property lines shhown FOR on this plan arethe lines dividing existing own- erships, and the lines of the streets and ways DR G AR Y E . T R A T T shown are those of public or private streets or - -- _ - — --" - --- --- DRAWN B'i ways olready established , and that no new DATE ' J U N E CHECKED BY R.FB. 16, 1976 � , � lines for division of existing ownership or for OR FRI a' new ways are shown SCALE : 1 " = 40' yU~,KI J ' 0 40' 80' 12o' do %47' r Date Registered Land Surveyor CHARLES N. SAVERY INC. REGISTERED CIVIL ENGINEERS & LAND SURVEYORS --- -- Reserved for Regisiry use. 712 MAIN ST. HYANNIS,MASS. 76033