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0536 SKUNKNET ROAD
65G <urk-i�4-0 - �. n .�v c W - ...,a �en,n a,;... ,� ,„.. �,.,. .. ,...-T � r.-..a.-- ,.�.e .,� .. ..,.� 4- �a+S!^-'�•m en..�*r..nrr.^^.ses6,r c.-�^rr irs c{' *'g'-�a� .. ,� r; DING PERMIT APPLICATION r TOWN,OF BARNSTABLE BUILDING .77 Ma Parcel r2 4 p � Application Health Division Date Issued, Conservation Division Application'Fee Planning Dept. Permit'Fee Date Definitive Plan Approved by Planning Board t��l3f itq Historic - OKH Preservation/ Hyannis Project Street Address Slild�v�C�✓ 7' /C�i( t Village L L Owner ! W I - 'Address 631, fXcj kx)-e� gci, Telephone y 2/ % ; /D. P Permit Request� eoua/ems STi�1��_Abbi all S o c!e IIVJ&4A-77.16 C-7!/�/� ItJD I �AMfN !�/ d1/®� Square feet: 1 st floor:.existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay - Project Valuation O Construction Type Lot.Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) oRiy��v/fG Age of Existing Structure _ Historic House: ❑Yes >No On Old King's Highway: ❑Yes )(No Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq•ft) Number of Baths: Full: existing_, new Half: existing new Number of Bedrooms: existing 1 new Total Room Count (not including baths): existing _ new First Floor Room Count Heat Type and Fuel: )(Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing / New 0 Existing wood/coal stove: ❑Yes 0 No Detached garage: ❑ existing ❑Pew. size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing gnew size _Shed: ❑ existing ❑ new size _ Other: PART or- Tic A80lw on/ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 4 No If yes, site plan review# h a o Current Use _ �S! el-eNL 4 Proposed Use APPLICANT INFORMATION o - _ (BUILDER OR HOMEOWNER)_— :� .. o- - L Namer', 1- IffieLt Telephone Number 77 � ZO r' Address 'SkIlduAieTLicense # 4 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 3� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED 1 MAP/PARCEL NO. Y 5 ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION ` FRAME Q&12J1 ho INSULATION 60 ? V,in a FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING V `t�L41 i M t ,t a DATE CLOSED OUT x ` ASSOCIATION PLAN NO. J 4 ` ti . The Commonwealth of AVfassachusetts Deparfinent of Industrial Accidents Office of Investigations' 609 Washington Street Boston, MA 02111 :Y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers licant Information Please Print Legibly Name (Business/Organizationffndividual): 4 L L l Address:_ 636 SkUMM 1 i ity/State/Zip: l.4•eNMEc31/'r Phone.#: 77 2101, 1016 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the slab-contractors listed on the attached sheet. T. ❑Remodeling ..2.0 I am a sole:proprietor or'partfler-' • These sub-contractors have g_ '❑ Demolition ship and have no employees working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp.-insurance comp. insurance.$ 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions uixed.] . 3 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required-] t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' ci;mp.insurance required J *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. XContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure io secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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. o up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vesti ations of the DIA for insurance coverage verification. Id aereby certi and the ins and penalties perjury that the information provided above is true and correct e: Date: s — Phone# ZLf 219 1611,0 O•ffu ial use only. Do not write in this area, to be completed by city or town official. City or Town: Perrnit/License# Issuing Authority(circle one): 1.Board of Health '2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector �[ 6. Other. Contact Person: Phone#: r• Information and I.nstr°�ct�®�s ' Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. oyee is defined as every.person in.the service of another under any contract of hire, Pursuant to this statute, an empl express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal on 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 tiustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states.that"every state or local Iicensing agency shall withhold the issuance or renewal of a license o'r permit to 6perate 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." "Neither the commonwealth nor any of its political subdivisions shall Additionally,MGL chapter 152, §25C(7)states . the performance of public work until acceptable evidence of compliance�zth the insurance enter into any contract for. p 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-conttactor(s)name(s),-addresses)and.phone number(s) along with their certificates) of insurance. Limited Liability Companies.(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the.affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitllicense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or town).".A copy of the affidavit.that has been officially stamped or marked by the city or town maybe 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 fo any business or commercial venture (i.e. a dog license or permit to burn loaves 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 _ Deepartmant of ladustrial Accidents Office of IuvestigadQus- 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 11-22-06 www.mass.gov/dia Town of Barnstable o Regulatory Services ' Thomas F. Geiler,Director • RARNSTABLE, KA-ca Building Division ATfD '�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 •� pp Please Print DATE: iJ� r✓ 7 10B LOCATION: 7 3a JII1(JNK/�� ^� �6�� ("`---- �jnumber I street village "HOMEOWNER": 1 14kf #_0 n k`INC,44 Hft1,e L- 77V z/1 /o b name , home phone# work phone# CURRENT MAILING ADDRESS; ,1v 3 G S1<_0AJ K 1V CT oeC/ Cc W 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 stipervisor. .' 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 thejbuilding permit. (Section 109.1.1) The undersigned"homeowner".assumes�responsibility for compliance with the State Building Code and other applicable codes,bylaws,rul,esand regiulationg. 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 �requir ent . • 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:\WPFILES\FORMS\homeexempt.DOC Y BIKE 'Town of Barnstable Regulatory Services HARNSTAID Thomas F. Geiler,Director 1639. �,�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.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 to act on my behalf, in all matters relative to work autho by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for pen-nit please complete the . Homeowners License Exemption Form . Q:f ORMS:OWNERPERMISSION �AaKiu� W j fti 7e(cF �Au2014. tNF,.RGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE. AND TWO-FAlYIIL" V DETACRED RESIDENTIAL'CONSTRUCTION (780 CMR 61.00) Applicant Name: �I4NA20 eikdy `'��� Site Address: 6 3(o 5 9U Ai print Town: Applicant Phone: 77 q Z/5 /0 16 Applicant Signature: Date of Application: ' 3 /-0 aj NEW CONSTRUCTION: choose ONE of the following two•o tions 780 CKR TABLE 6107.1 PRESCRIPTIVE ENVEi vPE C0NxP0NENT CRITERIA FOR NEW ONE- AND TWO-FANRLY BUILDINGS MAXIMU M MINIMUM Ceiling or Slab QOption 1: Basement Fenestration exposed ; Wall Floor Wall Perimeter AFUE HSPF SEEI U-factor floors 1Z-Value R-Value R-Value R Value R-Value and Depth National Applianm Energy R-10, Conservation Act(NAP-CA)of .35 R-3 8 R-19 R-19 R-10 4 ft.. 1987 as amcndcd,minimums or cater as applicabIr Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: REScheck Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 REScheck--Web which can be accessed at http //www enerYcodes.fro /rescheck/ ADDZt OIVS;OR;A,7�`z�"TZOl�S.I O EK[S RING��DfNds,.O R 5 SEARS OLD* *)3uildings under S years old must.use option#1 or 42 in New Construction section above. Complete the following formWa to determine the %o of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b - a) SF 100 x - _ % of glazing 6 a (b) Glazing.area equals . SF If glazing is<-40%.u9(-,the chart beloW. • . If gla2ing is > 40 % rocee.•d to "SUNROOM" section 780 CMR TABLE 6101.3. PRESCRIPTIVE ENVELOPE COYEPONENT CRITERLA.ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM NE NNIMUM Ceiling and Slab Perimeter Fenestration Exposed floors -wall Floor Basement Wall R-Value U-factor R-Value R-Value R-value R-Value and Depth .3 R-3 7 a R-13 , R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R,37 if the insulation achieves the full R-value over the entire ceiling area Q.e. not compressed over exterior walls, and including any access openings), SUNROOM—An addition or alteration to an existing building/dwelling unit where the total Eglazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information.Form found in Appendix 120T R BOISE" Triple 1-3/4" x 18 VERSA-LAM® 2.0 3100 SP, Roof Beam1RBO1 BC CALC®2.0 Design Report-US 2 spans No cantilevers 10/12 slope Tuesday, October 13,2009 08:02 Build 287 He Name: BC Job Name: Description: RIDGE Address: 536 Skunknet Road Specifier: Joe Madera City, State,Zip: Centerville, MA Designer: Customer: Richard Miller Sons Company: Shepley Wood Products Code reports: ESR-1040 Misc: 12- 12-00-00 30-00-00 BO,3-1/2" t B1,5-1/4" B2,3-1/2" DL 0 Ibs DL 7,741 Ibs DL 3,090 Ibs SL 2,137 Ibs SL 11,537 Ibs SL 4,668 Ibs Total Horizontal Product Length=42-00-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load Unf.Area (psf) Left 00-00-00 42-00-00 15 25 15-00-00 Controls Summary Value %Allowable Duration Case Span Disclosure Pos. Moment 46,268 ft-Ibs 57.5% 115% 194 2- Internal Completeness and accuracy of input must Neg. Moment -52,825 ft-Ibs 65.6% '115% 3 '1 -Right be verified by anyone who would rely on End Shear -6,636 Ibs 32.1% 115% 194 2-Right output as evidence of suitability for Cont. Shear 10,025 Ibs 48.6% 115% 3 2-Left particular application.Output here based Uplift 2;793 Ibs n/ on building code-accepted design ° n analysis methods. a 194` 1 -Left properties and Total Load Defl. L/291 (1.229 ) 61.9/0 494 2 Installation analysis engineered wood Live Load Defl. L/477(0.749") 50.3% 194 2 products must be in accordance with Total Neg. Defl. 0.133" 17.7% 194 1 current Installation Guide and applicable Span/Depth 19.8 n/a 2 building codes.To obtain Installation Guide or ask questions,please call %Allow %Allow (800)232-0788 before installation. Bearing Supports Dim.(L x W) Value Support Member Material BC CALC®,BC FRAMER@,AJSTM, BO Wall/Plate 3-1/2"x 5-1/4" 1,873 Ibs n/a 13.6% Unspecified ALLJOIST®,BC RIM BOARD TM,BCIO, B1 Post 5-1/4"x 5-1/4" 19,277 Ibs n/a 93.3% Unspecified BOISE GLULAMT"' SIMPLE FRAMING B2 Wall/Plate 3-1/2"x 5-1/4" 7,758 Ibs n/a 56.3% Unspecified SYSTEM@,VERSA-LAM®,VERSA-RIM PLUS®,VERSA-RIM®, VERSA-STRAND®,VERSA-STUD®are Cautions trademarks of Boise Wood Products, Uplift of 2,793 Ibs found at span 1 -Left. L.L.C. For roof members with slope(1/4)/12 or less final design must ensure that ponding instability will not occur. For roof members with slope(1/2)/12 or less final design must account for Rain-on-Snow surcharge load. Notes Design meets Code minimum (L/180)Total load deflection criteria. Design meets Code_minimum(L/240)Live load deflection criteria. .z I Page 1 of 2 BOISE- - Triple 1-3/4" x 18" VERSA-LAM® 2.0 3100 SP Roof Beam1RB01 BC CALCO 2.0 Design Report-US 2 spans I No cantilevers 1 0/12 slope -Tuesday, October 13,2009 08:02 Build 287 r File Name: BC Job Name: Description: RIDGE Address: 536 Skunknet Road Specifier: Joe Madera City, State,Zip: Centerville, MA Designer: Customer: Richard Miller Sons Company: Shepley Wood Products Code reports: ESR-1040 Misc: Connection Diagram Disclosure b d— Completeness and accuracy of input must be verified by anyone who would rely on a . . • output as evidence of suitability for o o particular application.Output here based c on building code-accepted design properties and analysis methods. • • Installation of BOISE engineered wood e o 0 o 7777products must be in accordance with current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call a minimum=2" c= 13" (800)232-0788 before installation. b minimum=3" d= 12" e minimum=3" BC CALC@,BC FRAMER@,AJSTM, ALLJOISTO,BC RIM BOARD-,BCIO, Nailing schedule applies to both sides of the member. BOISE GLULAMM,SIMPLE FRAMING Member has no side loads. SYSTEM@,VERSA-LAM@,VERSA-RIM Connectors are: 16d Common Nails PLUS@,VERSA-RIM@, t VERSA-STRAND@,VERSA-STUD@ are trademarks of Boise Wood Products, L.L.C. j Page 2 of 2 .Q TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# X 9 6 3 U Health Divisi n 1"7 /�If�1�- Date Issued Conservation Division e57, ! � L)-0 6 8: lication Fee D Tax Collector�1�.— r����6 5— herfiNISTALM IN mit Fee WITH TIME.5 � Treasurer MAIR 0NIMEl' TA C 0 D E Ao WM Planning Dept. V 7GULATlo� , Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis " Project Street Address N kkoc Village Owner i;r" N1� te-a Address 6'3 eP..jk<v,//ee 00, Telephone 0 Permit Request I _NGl J c.� � kjcleAJ, A"k-4-edrov^ (r� ► �� a� Square feet: 1st floor: existing 67 L propose 2nd floor: existing I proposed �oG0 Total new ;:honing District �' �Q t L-L Flood Plain oun ater Overlay.. Project Valuation 60 000 Construction Type wok Lot Size 1-11110 5F Grandfathered: ❑Yes EfNo If yes, att h upporti mentation. Dwelling Type: Single Family M/ Two Family ❑ Multi-Family(#units) Age of Existing Structure 22 Y`S. Historic House: ❑Yes �26o On Old King's Highway: Yes Basement Type: ®(Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) !A7 Basement Unfinished Area(sq.ft) 57(o Number of Baths: Full: existing i new I w Half:existing new o a Number of Bedrooms: existing 3 new L k Total Room Count(not including baths): existing S new 2, First Floor Room Count -3 N si Heat Type and Fuel: [/Gas ❑Oil ❑ Electric ❑Other { c� Central Air: ❑Yes ®No Fireplaces: Existing f New Existing wood/coAtove: ❑-ales •,'0 No N � Detached garage:❑existing ❑new size N a Pool: ❑existing ❑new size A)(A Barn:Lieig Li new size �' A Attached garage:❑existing ❑new size ,3o 19t3 Shed:❑existing ❑new size "' n` Other: o►L- w � Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes l�No If yes,site plan review# Current Use 7' Inc Proposed Use se (Z,,Mly �r -- BUILDER INFORMATION �Name7 Z7elephone Number :50 9' `/Zfs—l�jdS Address 5'X SV_ k.,k 2l License# 3,2 Home Improvement Contractor# Worker's Compensation# AIL,CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO c SIGNATURE ' DATE FOR OFFICIAL USE ONLY ,, PERMIT Z40. t DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER t DATE OF INSPECTION: // f FOUNDATION FRAME (a 23)0(o INSULATION FIREPLACE ~- ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT , ASSOCIATION PLAN NO. v � I j TW6 TOWN OF BARNSTABLE Permit No. ----------_---------- Building Inspector Cash ------------------------- � rua 00�0 YPY \� OCCUPANCY PERMIT Bond ---- "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address CO-rnla"!Ae- Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ................................................... .. 19 ..................................................................._.........._�_....__.... .�. .__ Building Inspector p A Ness is map and lot number ......1 ..1. 1 S 4 w 7NE `i To Sewage Permit number VZ.C/,�...................................... I MA" 9T11D LE, �. House number ..... ...s . 4....... - .............................. 9. ��}MC SYSTEM �� 90. b a �++ ..... . ....... . p���. STAUED IN CO&I TOWN OF BARS . I I E%A§6 TOE REGULATIQNS BUILDING INSPECTOR Build Dwellin APPLICATION FOR PERMIT TO ............. ......................... TYPE OF CONSTRUCTION Wnad.. gamt .....: ,. { ...........M4y....1 A.....................198 TO THE 'INSPECTOR•OF,YBUILDINGS: The undersigned hereby applies for a permit according:'to the `following.information:. Location Lot 4 Skunknet Road,,,,Centerville, ,,;.. :. ..................:........:... f r ! ........... ... ........ ....... • ,zj Proposed Use ......Sin le Fam..lx..Dwe 11 in9............. .... ... ....................... ......... ................ Zoning District ..,,Residential,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,Fire District .......... en er.Vil.�e.-ASt. .TV:1.1°�R. James K. Smith . Name of Owner .................................................................... Address ...............�a2RStab1�:....:.....:................................... ' Name'of Builder James K.. Smith........... .............. .Address ................$amsCab.le............................................... Name of Architect :.......Address Number of Rooms f our Foundation ......... d..p.oure. aomcreto......} ;,.. ,,.: N Exterior P............ ..... .'Roofing EtSphr hl»..Sb�ng.1es............. ................ c1A, board & t 11`1 Floors ....................wal.. .,to„wall.............. ........... .........Interior ....... %dryv'. ....................................... Heating electric...............................................Plumbing ;:sae..bath.....and.. ..bath............... Fireplace .................Qne...........................................................Approximate Cost .,$40*QOA.................... 1 Definitive Plan Approved by Planning Board ____________ _________________19--------- ; Area .,..... ............ .:...s... ras- Diagram of Lot and Building with Dimensions Fee .:........... $ ................................ -SU$JE,CT. TO APPROVAL;,,-F BOARD OF HEALTH 24 x 24 2 *tory .e 4. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. vv Name ................................ SMITH, JAMES K. 2311--Z Two Story lKlo ................: PjiPnit for .................................... Single Family Dwelling ............................................................................... Lot #4, 536 Skunknet Rd. 4ocation ................................................................ Centerville ............................................................................... 2� Cj Owner ...(Aame.s...K......Smith.......................... ....... .. .. . ....... ..... V 71 Type-of Construction ....Frame...................................... L 71 ............................................................................. Plot ............................ Lot ................................ Permit Granted ......May...13 ...............19 81 L Date of Inspection .........................H.........19 Date Completed .................... 19 0 rn V) S PERMIT REFUSED fA 0 ...... 19 ............... ....... ..................... Z: C > ................ X N ............... .......................................................... C' 4 ............... . I Me, ,...v......... .................................... Cq 4a ;A > .. .. .................................................... 0 Approved ... 19 ............................................................................... Da/ k...................................... 4, Assessor's map sand lot number ......./.(t..�.. ..1 ?`.... P. r *THE T Sewage Permit number ..................................... . 0. Z BJB39TADLE, i House number ............. .!-.3 zn 9 MAe� ................................. �p 16 0� �Fp MAY a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO Build lNe l l f n .................................................................................................................. .......... TYPEOF CONSTRUCTION ..................................................................................... ...........'�aX...1..... .....................19:?1.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the .following information: Location Lot 4 Skunknet Road,...Cent� 'vi ll�................................................................................................ ....................................... ProposedUse ......5. n .le...FAtni lv Dve l l in�...................................................................................................................... Zoning District ....Itesid.entfal Cent�atN ..a ,e+,«n lr xyi.l.tP.......... ........................................................Fire District .........:........... Name of Owner ..James... A..Smith.....................................Address ............... ,,a kmttaa............................................... Name of Builder james... • Smith ..............Address Baer+ t�.' .lp............................................... ...................................... ................. Nameof Architect ..........................:.......................................Address .................................................................................... Number of Rooms our..............................I.........................Foundation Yxgn pA..;.mc,,retin .........,. .................................... Exterior clauboand & tmf 11, ...Roofin !SnIlpIt... ............................... Floors ....................wz11 to wall . . ... .. . .......................................Interior .................r. e t Heating e.lectrfo �,.. herb n.t �,�r►. ...........................................................Plumbing .................................................................................... Fireplace .................MAR...........................................................Approximate Cost ...... . .....SW),.��............................ . i Definitive Plan Approved by Planning Board -------------------_-----------19________. Area .......>:. .... r ....... Diagram of Lot and Building with Dimensions Fee c�`� � SUBJECT TO APPROVAL OF BOARD OF HEALTH -)06 24 x 24 2 stork I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name !?.. ................................ SMITH, JAMES K. ----._------_------/—f \ ~ Location .J���t�..��4L~..�i3�i..-----.!�eJ}�eJ��ilJ'e.----. ^ , Owner —J aM.P-5...Z°—Sozitb.......................... � Toe of Construction - Frame . . i Plot Lot � � � Permit^ ~'~^'~~ Date of Inspection ...........7.........................19 PERMIT REFUSED - - . � � - r ................................ .............................. 19 � � .--------..... --~---.---------.. . —.-.---..--.-----~--..--------. ` ................................ Approved ' ................................................ lQ ---------------'--^----~---' � --------------------^^^'—^^^'- .e-- ram• r a.• �ran _ .. St Li G LE FAM I L-%.(.- 3 lto t 3 330 GAP- I u Kr-- io oO [; { V1SPc>SAL. PtT V;e 1000 61t, `` Slt�a,vpLL Ae•6A 4.150 ��'.. . .. . � _ ! _.._.._.-... I ... .�__._.._..A.ect�_----.._:.. _. � �: O ' f 6oTTOM AJREA•';So" 5Tr 50 I •n 50 9M.., ToTa P�P �i g' VSZZoLA-r IOW 2AT1 t•.I w % ftw o2 qq 41 Y .. W. 31048 j "TEST 8 80 LoaM 4'pve :i ' '97 . /0 0 o Z�Z I►l�t 8oi: 9��' TTILUUK 9G WV IA � l cuo ryv. SAS bsL. 9�Z 0,0 - 'PIT _ WtTat� tusSu� •: � GTO N 6 EG�390 ' t, �a . �Qo FI L.Er i Lvov, rtow (foTV I12' T . cam..p L= 1 t: ac; V/l)Try, 1 G�aCTt�Y T4tAT 'rtpE 'F0VNDA-ricIJ Stlowe♦.J 1-4EQrE.O11 GoticP�-YS 10�/lTN T4i4 ;IDEl.1�JlSr. Lar ( A ANt> st_-rB r_W. jZw4ute —MAAa" ; of TW& �:. AR pc,AIJ rorz- Lbwti of l �.k .S. Trz.vsT 4UZVE�P E T441S PL&W 14 UOT ISA5ED 0L&I AU 16KTP)MEE6AT 0erTEZV%LA-6 A+tLcoS. 5ur.VC( TtA GL 0t=rr'9ET; i"OULU U T lsr. t3"r�•D APPI.tG A WY �/ fThe TownBarnstable of " of Health SafetYv1 Building Division 367 Main Street,tlyannb,NA 0201 30&8624938 Fax, 5£8-790-6230 Pro*t Address, The following items were noted On reviewing. YI a_--------- � Revved try: Date Town of Barnstable oEt'�rqy ti Regulatory Services • • t $ Thomas F.Geiler,Director 2639, �• Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us nee: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EREMPTION Please Print DATE: OS JOB LOCATION; village number • street " "Ji0ME0WNER : workP hone# name - ome phon e# CURRENT MAMING ADDRESS: Ge C.�ye�tL M n2.(re 3Z 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 su ep raisor. 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 rec�onsible 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 pr edures and requirements and that he/she will comply with said procedures and requir Si ature 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 1o9.1.1.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-=not 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 pernnt 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 forn✓certification for use in your community. R F, YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost$30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1$' FL., 367 Main Street, Hyannis, MA 02601 (Town Hall). DATE: n Fill in please: ' APPLICANT'S YOUR NAME: t-rg r, + Y 06VI g 0-"1�► l ) p B SIN SS YOUR HOME ADDRESS u I 0 U, t1�� A- 0. *3- TELEPHONE # Home Telephone Number: t�� r: r fiIAM F T�`RE IT1E Si ..::..,WEB _....... _...r - . r: When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO TONER'S OFFICE This indiv' ual h been o d of an�- y permit retirements that pertain to this type of business. A horize ^ignature** COMMENT : " y d 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY)- This individual h en infoL d of thn i g uirements.that pertain to this'type of business. Auth rized S' nature** COMMENTS: 0 Town of Barnstable. s ° Regulatory Services �pF THE-1p�� P Thomas F.Geiler,Director . snaxsr`Aar.E, Building Division - vMAM Tom Perry,Building Commissioner afigq. �� 200 Main.Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 ax: 08-790-6230 An-Droved: Fee: Permit#: C3 HOME OCCUPATION REGISTRATI N Date: Name: f�t o Phone#: sue- V ad— I y Address: _�5 3 b S(L-"i1 aE X'-QC-(p R Village: 1"4" If Name of Business: lO M C e Lam+1 D(o,P ��U�n(' `� ►J�%i( jG s // Type of Business• t_9�4 - Map/Lot: � l� p / B l s/UD Ll INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the. premises which would suggest anything other than a residential use;no'increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within . that dwelling unit -Such use occupies no more-than 400-square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration, smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by.such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. . • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary_Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home.Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the � dwelling unit 'h I,the unde ed,have ead and agree with the bove restrictions for my home occupation I am registering. Applicant- tLzc Date: Homeoc.doc Rev.5/30/03 oFe r Town of Barnstable Regulatory Services BAwsrasrs, Thomas F.Geller,Director y 4A i6�9 �,,� Building Division , rED MP'� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax:.,508-790-6230 Office: 508-862-4038 Permitno. . 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 • cent to four dwelling units or to structures which are adjacent e but not more than fo g containing at least on building g b g such residence or building be done by registered contractors,with certain exceptions,along with other requirements. _ e) .a�•j Type of Work: Ce sk��c .�a �� A r.'ti. Estimated Cost Address of Work: ✓, Owner's Name:- Date of Application: /005 hereby certify that Registration is not required for the following reason(s): []Work excluded by law: ❑Job Under$1,000 ❑ uilding not owner-occupied [Owner pulling own permit . Notice is hereby given that: . '` �, . • OWNERS PULLING THEIR OWN PERMITOR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDERMGL c.142A. SIGNED UNDER PENALTIES OF PERMY I hereby apply for a permit as the agent of the owner: ate Contractor Name - Registration No. OR Da Owner's Name Q:forms:homeafFidav a RESIDENTIAL BUILDING PERMIT FEES MPLICATION FEE ; New Buildings $100.00 Residential Addition $50.00 { Alterations/Renovations $50.00 Building permit Amendment $25.00 FEE VALUE WORKS MET NENV LIMG SPACE IL2. square feet x$96/sq.foot= plus from below(if applicable) -�ALTERATIONS/RENOVATIONS OF EXISTING SPACE square Q feet x$64/s°.,foot'" ��2 x 0041= O 0• �Z plus from below(if applicable) GARAGES(attached&detached) p [s, square feet x$3Vsq.ft. --x..0041= ACCI,SSORY 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 PERMTS Open Porch (number)x$30.00= . . • Deck x$30.00= (number) • Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground SwimmingPool $25.00 Relocation/Moving 5150.00 (plus above if applicable) Per Fee Projcost Rev:063004 B��SEry BC CALC®2003 DESIGN REPORT- US Thursday,October 13,2005 07:35 Single 11 718" 13CI®900s SP File Name: Stingray Ent.,Frances Tyning.BCC:JO1 Job Name: Frances Tyning Res. Description: Address: 536 Skunknet Rd. Specifier: Botello Lumber Co.Inc. City,State,Zip:Centerville,Ma. Designer: Cape Surv. Customer. Stingray Ent. Company: Code reports: NER 594,ICBO 5208 Misc: Standard Load-40 psf 110 psf PC Spacing 16' BO,1-3/4" B1,1-3/4" 587 lbs LL 587 lbs LL 147 lbs DL 147 lbs DL Total Horizontal Length-22-00-00 General Data Load Summary Version: US Imperial ID Description Load Type Ref. Start End Type Value OCS Dur. S Standard Load Unf.Area Left 00-00-00 22-00-00 Live 40 psf 16" 100% Member Type: Joist Dead 10 psf 16". 90% Number of Spans: 1 Left Cantilever: No Controls Summary Right Cantilever: No Control Type Value %Allowable Duration Load Case Span Location Moment 4033 ft Ibs 47.5% 100% 2 1 -Internal Slope: 0/12 Neg.Moment 0 ft Ibs n/a 100% OC Spacing: 161, End Reaction 733 Ibs 51.5% 100% 2 1 -Left Repetitive: Yes Total Load Defl. U478(0.552") 50.2% 2 1 Construction Type:Glued Live Load Defl. U598(0.442'I 80.3% 2 1 Live Load: 40 f Max Defl. 0.552" 55.2% 2 1 psf Span/Depth 22.2 n/a 1 Dead Load: 10 psf Partition Load: 0 psf Notes Duration: 100 Design meets Code minimum(L/240)Total load deflection criteria. Disclosure Design meets User specified(L/480)Live load deflection criteria. Design meets arbitrary(1')Ma)dmum load deflection criteria. The completeness and accuracy of Minimum bearing length for BO is 1-3/4". the input must be verified by anyone Minimum bearing length for B1 is 1-3/4". who would rely on the output as Entered/Displayed Horizontal Span Length(s)=Clear Span+12 min.end bearing+12 intermediate bearing evidence of suitability for a particular application. The output above is based upon building code-accepted design properties and analysis methods. Installation of BOISE engineered wood products must be in accordance3(� d with the current Installation Guide and the applicable building codes. To obtain an Installation Guide or if you have any questions,please call (800)232-0788 before beginning product installation. a BC CALC®,BC FRAMER®,BCiO, Ge BC RIM BOARD-,BC OSB RIM BOARD-,BOISE GLULAM-, VERSA-LAM®,VERSA-RIND, VERSA-RIM PLUS®, VERSA-STRAND-, VERSA-STUDS,ALLJOISTO and AJSTm are trademarks of Boise Cascade Corporation. Table JLLI'b(continued) Prescriptive Fackagea for One and Two-Family Residential Building Heated Vdib Fossil Fuel MAXIMUM MINIMUM Glaria ' Ceiling Weil + f7°or Baxmeat Slab Hearing/Cooling .t3laang g perimeter Equipment F16cieacy' Arras(6/1) U-value= R-values R value R value well R valuer Package R-value 5101 to 6500 Heating Degrre Days' 13 l9 IO 6 Normal 12% 0.40 38 Q' Normal _ 30 . 14 19 IO 6 3E 13 19 10 6 E5,�E P1/A Marra 3E. 13 2S N/A Plam�ai-- Ci 0.46 38 19 19 10 6 - ---- 23 N/A 13 :NIA ES:AFiJE :. IS AFUE W 1Sl. O.S2 30 19 19 10 6 X 18'!e 032 ' 38 . 13' U NIA NIA Normal. Y 11% ' 0.42• 38 19 25 NIA N/A Formal Z 18% 0.42 78 13 19 10 6 90 AFUE AA 18% 0.50 30F 19 19 10 6 90 AFUE 1.-ADDRESS OF PROPERTY: 5,360 C � cry 11� nn 0'Z(o3�— - 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS:. 3. SQUARE FOOTAGE'OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-sea chart above): NOTE: OTHER MORE H�IVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q•farms-980303 a 780 CMR Appendix J f' � h• Footnotes to Table A2.1b: assemblies (Including sliding-glass doors, skylights, �.nd 3 Glazing area is the ratio of the area of the glazing i g gross wall basement windows if located in walls that enclose Total lazing area may be excluded frooned space,but excluding m the U-valuer equirenient. area,expressed as a percentage.Up to 1/a of g For example,3 ft of decorative glass may be excluded from a building design with 300 if of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3A. U-values are for whole units: center-of-glass U-values cannot be used. ' The.ceiling.R values do not assume a raised or oversized Truss constriction. If the e i s lahori subs#ihieves the t�tcd for fall ss over the extenor walls without compression, R 30•insulation :Y thzckne insulation � _ ;_..i._ r insulation as-a R=3'8 insu�a ion may bb'stibstiluted'fofS 49 insula�tl'on:,C uihng R gPmust be placed between tilated cei , g insulation plus insulating sheathing (if.used):For ven &g the conditioned space and the ventilated portion of the roof. if used Do not include' 'Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing'(• )• exterior siding,structural sheathing,.and Interior drywall.For example,an R 19.regniz me�c uI gem etapply IM exto R 19 cavity insulation OR R 13 cavity insulation plus R 6 insulating sheathing. qn wood-frarbe or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame constriictioa. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawl spaces,basements, or garages).Floors over outside air must meet the ceiling requirements. 'Tne entire opaque portion of any individual basement wall with an average depth less than50%below s. conditioned. de must meet the same -R=value requirement'as above-grade walls. Windows and sliding g.. basements must be included with the other glazing. Basement doors must meet.the door U-value requirement described III Note b• '.The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes elebtric resistance heating use compliance approach 3;4,'or 5.•*If you plan to'install more than one piece of cooling equipment,the equipment with the lowest than one piece of heating equipment or more efficiency must rneet.or exceed the efficiency required by the selected package... 'For Heating Degree Day requirements of-the closest city or town set Table J5.1.1a NOTES: R-Yalues are a)Glazing areas and•U-values are maximum acceptable,l component acceptable-levels. R value requirements are for insulation only and do not include structural b)Opaque doors in the building envelope must have a U-value no greater than 0.35.Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table 11.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e„May have a a e wall component goner than 0.35udes two or more areas with c)If a ceiling,wall,floor,basement wall,slab-edge,or cmwl P different-Insulation levels,the component complies if the area-weighted average R value is greaser than or equal to the R•value requirement for that component.Glazing or door components comply if the area-weighted average U- yalue of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 I reformation aiid Instr uctions eral Laws chapter 15Z Yegnires all em�p yeas pro ensatioa for their employees. to to vide workers' comp' contract ohire; Massachusetts Gen person in the service of another under any punt to this statate an.employeE is defined as ,...every p , express or implied,oral or w> •" two or more bclzvi¢pal,, oration or other legal eutkv, O ,any ,. pa�tp,ersl}ip;;assoaation, f4rP to er or the' An employer is defined aS" and inctading the legal representatives 6f a deceased emp y , of the foregoing,engaged in a joint enterprise, . partnership,association or other legal entity,employing emp loy • Ho�telterAe receiver or trustee of an individual, ees Y ant of the owupr of a dwelling house having not more than flireoe m ar� o�cowns uctition o rep airair woik•ou such dwelling house dwellinghouse of another who employs persons to d or on the ands orbu�ding appurtenant thereto.shall notbecause of such em�ploymentbe deemedto be an employer." MGL chapter 152,§25 C(�`also states that"even'..state•or local licensing agency shall withhold the issuance or al of a license or pew to operate a business or to construct buildings in the commonwealth for anp renew produced acceptable evidence of compliance with the insurance coverage required." applicant who has not p subdivisions dditionaIly,MGL ch�apte?152,§ZSC('�states"Nei�.er�.e comawnwealth nor any of its'political sabdiviszons shall � p' erfoaaance of tlic work until acceptable evidence of compkance withe insurance enter into any contract for the p Pu 1egniremeats of-this chapter have been presented to the contracting au$iority." Applicants b y checking the boxes that apply to Your situation and,if. Please fill out tbeworkers' comq�ensation affidavit'completely, y - address(es)and Phone numbers) alongwi&.t wk certificates)of necessary,supply sub-contractors)nanne(s}; with no employees ether than.the insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships or LLP does have an members or p artners; are not required to carry workers' c aiaPensan'boe Atedto the DepCastment of Industrial employees,a,policy is required. Be advised that taus affid. may The affidavit should tton of insurance coverage., Also be*sure to sign and date the affidavit: arfinent of Accidents for confiraza not I)ep be returned to the ci*ar.town that the application for the permit.dr license is being requested, Industrial Accidents, Should you have any questions regarding the law or if you are required to _ _. ... lease cal1theDeparhmentatthenwmberlistedbelowti Self-inmred companies should"eatertheir compensationpolicy,p riate line. self-insurance license number on the appmp City or Town Officials Please be sure that the affidavit is complete and printed legl'bly. The Department has provided a space at the bottom the applicant of the affidavit for you to fill out in the event the Office fInvesti wbich used as as zeference number gatioi�has to contact you r In ad tion, an applicant' Please be sme'to fill in thepergnzt/hcense numb that must submit mitiple permitIcense 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 p stamped or marked by the city or town may be provided to the town)"A COPY of the-�davitthat has been officially stamp applicant as proofthat•a valid affdav--h o. fno for;future permits•or'liceases.•Anew affidavitmustbe filled out.eatrh year.Where a home owner or citizen is obtaining a livens is NO r not Yelated to any uired to complete thiseaffidavis Or �ercial venture (Le.a dog license or permit to bum leaves etc.)said personeq .: a you in advance for your cooperation and should you have any questions, The Office of Iuvestiga ions would 1'k.,to than_y . ' • please do not-hesitate to give us a call. TheDelyartment's address, telephoneandfaxnumber: The cm=onwealth of Massachusetts . Department ofIndustrial.Accidents dffice 9$Itivestigations . ; f 600 Washington Street 4 Boston,MA,OZ111, "Tel.#617-727-4900 ext 406 or-1-877MASSATE Fax#617-727-774 u FnAePA 5-26-45 www.mass.aov/ilia The Commonwealth of Massachusetts Department of b ditstrial Accidents ' Office of Investigations, 600 Washington Street Boston,MA 02111' www.mass.gov/dia V. J Workers' Compensation Insurance Affidavit: Binders/Contractors/Ele�ct;i sdaris�{u�mb r Le iicant Infflrmation aaizatiov'1ndavid4-- �' ���. �' Q %V► c;-r.�.+�e.i\6 game P4=ss/Org Address• 53�, ' It . v243'ZPhone#: ���� ,.ye�—/S/05 State/Zip.. Ce _hype of project(required): ire you an employer? Check the-appropriate bon:. . •• , (] Z am a employer with 4. ❑ I am a general contractor and I .6, ❑New construction- employees (fa1T and/or part time}.* have hand the sub-contractors : 7 ❑ Remodeling ariaer- listed'on the attached sheet$ I am-a soleprogrietar or P These sub-contractors have 8. .❑ Demolition ship and have no employees. • marking forme in.any'capacity, workers' comp,insurance. g, ❑ Building addition [No workore comp insurance 5. ❑ "We' a corporation and its lo.❑ Electrical repairs or.additions required.] officers have exercised their right of exemption per MOL 11•❑ P.ImAmg repairs of additions 3�I am a homeowner doing all.work . c. 152,$1(4),and we have no 12.E Roof repairs myself.-[No workers comp. employees.[No workers` insurance required.]t 13:❑ Other comp.insurance required.] Any applicant that checks box#1 must also fill outthe section-below showing their workers'compensation policy information: `* Homeowners who submitthis aff►dsvit indicating they are doing ell•work an name ft outside wntractors must submit anew off Pbmdic tim Coatractcrs that check this box.must at�h��additional sheet showing the name df the sub-contractors and then workers� 47+`' am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and jab site. Information.' [nsurance•Comp ame' Policy#or Self-ins.Lie."#,• Expiration Date•_ Job Site Addrtss: City/State/Zip: — Attach a copy o he workers' co pensation policy declaration page(showing the policy number and•expiration datf)a Faihire to,se a coverage as require der Section 25A of MGL e. 152 Bari lead to the imposition of cnmmalpenalties tine .g ,50Q,.00 2ndlor one-year imprisonment, as well as civil penalties in le form of a STOP'W�RK ORDER and a fine of up t4$ :00 a day against the violator. $e advised that a copy of this statement rnap 6e forwarded to,the Office of Investigatidns of the DIA for insurance coverage verification. I do hereby eerh;fy er the pa a penalties of penury that the Information provided a ova is true and correct .i Date /6 atore: /✓r �� Phone* Official use only. 'Do not write in this area,to be completed by City.OF town offic4L City or Town: PerraWLicense# ; Issuing Authority(circle one): 1.Board of Health 2. w Building Department 3.City/Ton Clerk 4.Electrical Inspector S.Plumbing Inspector 6,Other ContaetPerson: Phone#• Vwx . _ .... � Aaack ` FBFPACA VM0.5 fiRE►.�CH t�ooRS 0 i t c h e,-r1 cl-- i n i. S. T f,,l� � 1 Plon Scale �/ 4 1 SH e x s i n�l IN ya. 4 1� �oo� FeatQyow9, .. C�oSe.� G �, p � i I t i 2 ND Fl(' )c ) r lll ( [ n r SCale 10 I i Z) oq O t y� M, { - •-o M T f; MASTED g- R ASH Ex15tin 2 y to wauOY t r �3edroom t � r o i \/\/A LV<-Z PSI i CLOSET- N ( 1 t I t i R-ewr-* E-te-w-iti-o n _�_�i�_._��__..r�,, _i _ --r_�.� r��y�Z� �r-�-r—___r_....�._. �_� I T I Ti �- 1 r a r. -I _:_�-___._ - �.�._ I i 1 ! ` .......... Pg . 8 C-russ section 7ovb�e 2" x 12 I,VL As z'X y`� K� S•�as Ul I i i I N �,--V-h; l J ,t ._� �{ i� CJ w�Cre.>•'c. S�.c,y� 12��X 18•� Fvok � 'f/ PG_ -Hro-nt Ete-votion _Sca-1-e--/4- - �— r 1 . 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ING Floor 2 i - - 1 � I _ E�CISTING i -_te I I I I I 0 r _ n r- � e SMOKE DETECTORS REVIEWED -� T+SL BUILDI�60EPT— DATE — FIRE • — ----__ DEPART���EN i DATE j GOTH SIC;IJATURES ARE REQUIRE D FOR PER/�° r I UI OA I ICE 1,f ��� x . � . _ . — _ ,i • • Tit' E ST, ILDING D PATE BARN / E I �.r LNTfiY 'Jo�R i FIFE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTIN13 � Uan � nU I � l :.i 5 3 t 3 2 EX i STI SIG HOUSE �� U. r c -In by : Uougl (is an a n i ell o C3 x -7 R,II CID , s ........... - • - .. � 2x I v IUD .. ' EXISTING _G A R A CG E. • •i� , . -� -- IT I ; , - - Y • i r ! t , E` G VA LTE , U _� D- C 1 I N , Floor 2 . 1 x . r E 0- e .. a ! •r _ a a. Z--110 , m s r .. ( ., .• ; ; ; i + i i •`'' fir" - F i ! E' i f i i i s ! i r 1 i i I t fi 1 -- I I: L: `j t' i . I d f' I' i a j i r , • f / ` 1 h a _ jj 3LL. 5 , � t.i �I •I � � 'j I '� � � 1 � , �r S • u x ti a • a 1. , r .. 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I _..J ! __L. �_I__ .-_!-----.l-.___�- .-. _�_ � _.- l_--.L. f _._1------_L _-!_.__�. l :_.J�_..-•-f--•- i t. - - J -1-- __.1__- I I I , , i I -_ -►--- ' ' �_I _� . ..t... .... .- � ..._!�1__ Vl:.-_. _C..... _ r_. . 1:-_ a- --�---1-- � - i . .) I _I_ . T ►, �... .� 1- --L- -- �- _)_ _f_:_ _.. .. t. - --1_. __i....,_ _.�._.__1.. __J:._-�!_ l_.. _!___. I 1._ ! ._ i ! . ! I ► 1 . !_. - •�.-- -Z----_!_____-I - _1.__...---�.._.�.. I � � I _1 l 1----- ----- J ......_ I .;_ . . l:: �- . � I�---1 � I _�_ �__�,!____1_.__1_f _.-•'�=i�-_r � i _.�r � ' I --�_��__t ..�_ ... ! I__-J �..._-_�_----' ��_=� I -1-- - �- ---r -_I_- -----I I 1---- ���-�1--�---T , _fir_r- 1-1 I i _ I --!- --?=�- - - I - !- --- --!--1 -!- - -_! ► -- - ram- I r ---t-- I _ i I m 1 i I t1 • r�,'t .'S 20NE' CFNERAL WP,CP RC i r r, ' > System is designed in accordance with "Commonwealth of Mass, Dept. ' �** Area (min.,) 8712G SF (RPOO) 15. of Environmental Protection, 310 CMR 00; the State Environmental Code, f Frontage (min) 20' Title 5. Standard Requirements for the Sitinq Construction, Inspection, jKidth (min) 100' Upgrade and Expansion of On-site Sewage Treatment and Disposal Systems" Setbacks• and the Town of B14RNSTABLE Regulations Front 20' 2. Ho wells or water supplies are known to exist within feet of the 1 Side 10' proposed leaching system. All wells known to exist within 150 ft. of the 1 Rear 10' system are shown. 3. Prior to backfzlling completed system, notify the Engineer and the ' Board of Health for inspection. Provide 24 hr. (min.) notice. Y 4. Contractor shall be responsible for verifying location of all underground utilities prior to excavation., �, { 5. Any changes to this plan must be approved by the Board of Health. 106,4TIDN A4P ! 6. Area served by Town water 1 SCALE 1"= 9000'.t ! SITS' PL,1 N 30 ' ;1 REFERFJVCE 1 FLDOl y ZONE' Zone C ,Assr s ffap 169 Community Panel No. Parcel 15-4 #250001 0015 D 1992 o � 1 v � I 0VERLAY 0 STRICF 1 WP Wellhead Protection District o 21 As Shown on Plan Entitled "Revised Croundwater Protection Overlay Districts" - April, 1993 ohs, o i -`200- - i- l°hw 4 F l O EXISTING o ?6 F °-hw __ PORTABLE — - - CARPORT 1 i °s£ . �ro --.. sroc EXISTING CONCRETE o -ova FENCE PAD TO BE REMOVED EXCAVATE FOR 5' AROUND CHAMBERS AS REQUIRED TO REMOVE ° -2C2-- - -- 2or&1 - ss ``a _-- ALL SANDY LOAM ABOVE COARSE SAND (C2) LAYER. BACKFILL ,-1s s�� 1 16' (10' MIN) WITH MATERIALS MEETING THE SPECIFICATIONS OF 310 CMR p 1 202.t5 - 15.255 (3) AND (6). .NOTIFY ENGINEER FOR INSPECTION OF 32't 2p2_ EXCAVATION PRIOR TO BACKFILLING. PROVIDE ENGINEER EXISTING ELECTRIC 2.45 1 I 24-HOUR (MIN.) NOTICE FOR INSPECTION. o METER TO BE 02.60 EXISTING 202.43 1 RELOCTEO W _\ STONE ZG�-� 203.01 TH # � 16' 1 EXISTING GAS METER TO r o G 03.49 6 1... / ' o 3 REMAIN a 2, \l� ,..�, o ns o i N 20 .st 19CLZ,55 EXISTING SHED IN THIS AREA TO 1 / 202.95 BE RELOCATED AS + 20.7' 11(10' MIN.) i , 11' (10' MIN.) REQUIRED c 1 EXISTING 3. B.R. T.O.F ELEV.= �2'f ! DWELLING TO BECOME 204.46 4 B.R. PROPOSED ( W a 35x40' Ct ' ADDITION 203.3 I 3.73 T.O.F. ELEV.= 203.32 ! I REPLUMB EXISTING WASTE o 0 18 6' 03.31 204.46 PIPE AS REQUIRED TO CONNECT TO NEW y� / a 1 203.5 203.25 � ��OF ti,AS LE'G�'1V� PLUMBING 1N PROPOSED oS ADDITION. �a�� Sgcy 174.82, STEPHEN GJ, CONTRACTOR TO VERIFY EXACT , 58173 08 E o MATD. SON Test hole location LOCATION & ELEVATION OF PROPOSED EXISTING SEPTIC TANK CIVIL SEWER EXIT PIPE PRIOR TO SETTING f AND LEACHING PIT SHALL No.46345 0 �Q SEPTIC TANK. BE PUMPED DRY AND _'xisting contour REPORT ANY DISCREPANCY TO ENGINEER. REMOVED. ��F FGI S T e�� "x I NAL �N --203— Proposed contour * 0 o Pump Chamber (1000ga1) BENCffAZ4 A` �- TOP OF FOUNDATION t 00o Septic tank (16-00 gal.) ELEV=204.46' (ASSUMED DATUM) —0 Distribution box PRDP DON—SITS' S.LFX-40-E TR�'14T�1ENT ANI� D ISO SAL SYST_Eff aoa 41.5'L x 1.2.8'W x 2'D Absorption Chamber Prepared ,for.- 90UC AYT -F-R-4N ff,4yV0AA7ILL10 system o C.B. Concrete bound Location. 536 SAU-IVANET RO,4,9 B.4RNSTI4BL F (Centerville), .r ,4. —W— Dater line ffalSon -beSign Services NOTE.• TOPOGRAPHIC INFORMATION PROVIDED G— Cas Line 121 Sunset Strip Scale.' 14S SHOTYN BY CAPESURV, OSTERVILLS, MA. 1Llashpee, ILIA 02649 .Drawn by ,,5'DILI SURVEY PERFORMED 23/MAR/2005 ® Water pit Tel (508) 539 9062 .Date — ,VOVTffBER 99, 2005 Sheet f of 2 Job No. ODD/ PULP SPECIFICATIONS. 4. PUMP SHALL BE EQUIPPED WITH AN AUDIO AND VISUAL ALARM, INSTALLED IN A BUILDING TO PROVIDE ADEQUATE WARNING IN CASE OF PUMP FAILURE. ALARM SHALL BE POWERED BY A CIRCUIT 1. PUMP SHALL BE "BARNES" SE411AU (0.4 H.P) W/ 4. 12" IMPELLER SEPARATE FROM THE PUMP POWER. AND SHALL BE CAPABLE OF PASSING AT LEAST 1.5" 5. CHECK VALVE, AUTOMATIC. CONTROL AND CONTROL BOX SHALL BE SOLIDS AT A DISCHARGE RATE OF 6�.2 GPM C� 9.0 TDH. AS SPECIFIED BY PUMP MANUFACTURER. 2. PUMP SHALL BE INSTALLED IN STRICT CONFORMANCE WITH MANUFACTURER'S SPECIFICATIONS, 6. CONTRACTOR SHALL PRESSURE TEST FORCE MAIN TO ASSURE WATERTIGHTNESS. J. PUMP CONTROLS SHALL BE MOISTURE PROOF AND OPERATE IN THE FOLLOWING SEQUENCE. Z PUMP AND ALARMS SHALL BE INSPECTED AND MAINTAINED IN A) PUMP OFF ACCORDANCE WITH MAUFACTURER'S SPECIFICATIONS. B) PUMP ON C) ALARM ON 8. IT IS RECOMMENDED THAT A SLIDE RAIL SYSTEM BE INSTALLED TO FACILITATE REMOVAL OF PUMP FOR INSPECTION AND MAINTENANCE.' TrPM4Z S.Y,�5'°TEff P.RoFiZE Not to scale Tank to be installed on a level, THRUST BLOCKING SHALL BE stable base (min 6" stone base) PROVIDED AT ALL BENDS TO PREVENT DISRUPTION OF PROPER Top Of 20" OIA. COVER FUNCTIONING OF LINE, .20" I1ia. cover 20" Pia Foundation TO WITHIN 6' OF to �yitl�i 6 in, covers .Elev.=204.46' 11 of,W nasn grade FINISH GRADE ,� 14' elfin. c,, Inv.El. 3 10' 201.5' Ji w Note: q % M � NEYA 4X Outlet pipe JUNCTIONq to be level BOX for 2' 9x ,,•. .:'' •' - IJtQ r ------------- - -- - Inv.El. ---- - Ilia. ,�.. Flow line r- Scfiecd 40 P.P.0 BLEEDER 2" DIA. FORCE MAIN Scheel 4o P.Y.C. ®®®® 240.5' -L CHECK SCH. 40 PVC I500 Inv. F1, VALVE *Inv. El. Inv. El. GATE Inv. E1.=198.75 ®®®®®® 200.0 gRrlc 20z DO 201.83 4" cast iron Callon Ca city VALVE e ° L 0 a ' Se t2c Tank • ' � .. "• ALARM ON (195.92) -------------------- or sched.40 p f�4-OR 3" * P.V.C. pipe (Water taght rein!° cone) Inv.El. APPROVED PUMP ON (195.67) PROVIDE INLET TEE EQUAL. EXTENDING TO 1" Inv.El. •. . .. . . >99.0' 5-1 ABOVE OUTLET INVERT. PUMP OFF (195.25) Na arba e (SUMP) 200.,e5' allowed wi A this de xyn 9' Bottom .91ev.=194.5' PUMP 0H,4JfBFR .411 tees shall be cast iron maintain a maximum of 36"cover over . _.�.a � ry 000-GAL. TANK SHALL BE all system caTnvonents All components -- ©r, shed.40 P.1�C. o r po concrete. UTILIZED. INSTALL 01+1 A LEVEL, shall conform to sgaecxficat2ons contained Provide gas baffle on outlet tee. STABLE BASE. (MIN. 6" STONE BASE) in 310 b"MR 15.00, �1.8�5'`ORPTION Cf1,4.IYL.B.TR D�'T�41L (500-CAL. "ACW PRE'C.AS7` UNITS, OR E'QU M) Not to scald dfax, Final Grade 3/4"-f 112" ,%uble Flev.=205.3' washed stone -(typ.) Z'Jfin.1/8"-> Z' &inimum of(1) double washed inspectw' n cover stone (Typ) DZSICN DATA required ,,per unat Number of bedrooms- 5 9,0 Yin, cover Estimated daily effluent- 550 (Ezelua' top soil) Total leaching area as proposed- ------ ----- ---- ----- sidewall.' 9(L7-# x D 2>7.20 '; ®®®� ®®® ; ',5'T t�10L ' D 1 T14 Bottom: L x\ Or _ 531 xo' n ®®®EI®® ® � ► ° ° °n a e° 1 ®.®®®®� ®®.® j.. °o n n°bo Effective Leaching Casvactity as proses'' a°Oo as °n i ®® ® ® ° a° ° �' De1vth NO. 202.4, No. 202.4 (Effluent loading rate = 0.74GPOISF) ° ° ®� n aa = L- --------------- ..-..------"-----'-s n o°aoaa° aass a°oSANDY LOAM SANDY LOAM 160.? GPD an0° Bottomsidewall: 21720x0 74 B SANDY LOAM B SANDY LOAM TN OF Bottom: 531.2 x 0.74 = 393.1 GPI 201.9 20>9 Mgss [a4 O' 33.6" 4.0' q�y TOTAL = 553.8 f SIDES) (3 UNITS #'/4` OF .S'TONE IN BETWEEN) (4' SIDES) (5' min) C1 SANDY LOAM C1 SANDY LOAM �� STEPHEND. G 0/Day LFFF0TIYE' LFNGTff = 41..5 = Ll._194.4 MA SON 199.4' 199.4' CIVIL EFFECTIVE 1PIDTH _ M..8' SAX. H470 No.46345 C2 COARSE SAND C.2 COARSE SAND 90 �F0/ST0L*°a ' Ss�ONAI EN�'`� 19s 7' PROPOS.�'D ON- SIT ' s 'IY14t'r TI'�_1 T1 'NT �42V0 01S.POSAL sYS'TEff ? WA Z1 t or Prepared for-r. DOUC A.N. ? F.R.4N .� ,4NG'4NIF. Z0 MEDIUM � FINE. (No water encountered) T ,�• /� z;�/�'� r� C3 SAND v C3 SAND LT OCat ZO n, c13V S1'Ji(1 N N�1 R0�0, �' c'N,S'r 1 B.L. ' (Centerville), ffA. Date of test: 11/.23105 w Ins b Natson Design ,Services 194.4 EST. HIGH EST. HIGH J'. Aubick (ffolrmes&ffc 1,21 Sunset Strip Eval.� p Scale: 14S .SI'OKAT GROUND GROUND ILfasb e, AZ4 0,2"9 WATER 192 4 WATER >9z 4 Donald Desmarais (Barnstable ,tfealth .Dept..) Drawn bTel. 0 539 906°2 y SD.ILl 58 ( � Date - NOF'FffBTR 29, 2005 Sheet ©f , ' 'rob No. 000>