HomeMy WebLinkAbout0027 TUCKERNUCK ROAD r7elv-r-.Ife'lJe,7—
}
4
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 1-/ 7 .`"Application #C 1 6
Health Division Date Issued
Conservation Division : Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation/Hyannis
Project Street Address 2 7 Ilkkt^c4t,e-
Village rlo.l ruldz 41A,
Owner c,4c2 Ch j L14aA`eeA Address
'7aT -
Telephone 'Q S -2
Permit Request E/e, ' - a,rwierS. On/JC��
li' r +
Square feet: 1 st floor: existing 4Wroposed _ '2nd floor: existing CcAo proposed O Total new C9
Zoning District Flood Plain Groundwater Overlay
Project Valuation 60C? Construction Type
Lot Size 20•cx_)a Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family (# units)
Age of Existing Structure 2 S Historic House: ❑Yes I-Qo On Old King's Highway: ❑Yes WAo
Basement Type: ®'Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) i Basement Unfinished Area (sq.ft) !mod
Number of Baths: Full: existing new C? Half: existing 0 new
Number of Bedrooms: '3 existing _new 0
Total Room Count (not including baths): existing 7 new First Floor"Room Count 3
Heat Type and F I: Ur/Gas ❑ Oil ❑ Electric ❑ Other
Central Air: Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 0-Yes ❑ No
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: S/existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes 9'No If �es site plan review#
Y
Current Use D L10eLC t Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
t--; Name ZICILo 1'�., :: �CJr_.�`c Telephone Number C3 2 Ze; �2-'b.?_
Address )t"St S /Ue 62r;; S License#
Home Improvement Contractor# �G%
Worker's Compensation # '
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO la �✓'w �a G�
,J
SIGNATURE DATE �oi•°t, �/
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.,
ADDRESS VILLAGE
r
l OWNER
DATE OF INSPECTION:
,s
f? ;.FOUNDATION. S ' o 214h
FRAME ZZ3�11 f
� I
r
INSULATION
FIREPLACE
s -
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ?#' ROUGH - d:r >-_ : FINAL
CFINAL BUILDING:f,. �3171j=
DATE CLOSED OUT r
1 - •r
t ASSOCIATION PLAN NO.
t
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
t Boston, MA 02111
yy www,mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): P
Address: 17'0
City/State/Zip: /tt� �?g '` Phone M u�b 2
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 16 New construction
- to ees full and/of'"art tune .* have hued the sub-contractors..
f P Y ( r... ) Remodeling
2_ I am a sole proprietor.or partner- listed on the attached sheet. 7. g
ship and have no employees These sub-con tractors have. g. Demolition
working for mein any capacity. employees and have workers' 9 Building addition
No workers' comp. insurance comp. insurance.$ `
. qu
5. E] We area corporation and its
required.) 10.Q Electrical repairs or additions
3.❑ I qu 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 G. 152, §1(4), and we have no 13.❑ Other
employees. [No workers'
" comp. insurance required.]
•Any applicant that checks box M 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 con"etors'must submit a new affidavit indicating such,
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those enti ties have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number,
f am an employer that is providing workers'compensation insurance for any employees. Below is the policy andjob site
information-
Insurance Company Name:
Policy#or Self-ins. Lie.#: Expiration Date:
Job Site Address: ad Z� City/State/Zip; �✓ 2-_
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'Offlce of
Investigations of the DIA'for insurance coverage verification:
Ldo hereby certify inder the p ns an nalties ofperjury that the information provided above is true.and correct.
Si nature;�i�" .V Date:. ✓L; r
r _
` Phone#
Official use,only. Do not write in this area, to be completed by city or loivn official
City or Town: Permit/License#
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3, City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
".7 Phone#:
Contact Person:
THEr Town 6f Barnstable
- Regulatory Services
MAB& Thomas F. Geiler,Director
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
ts�vw.Eown.barnstable.ma.us „ , _
office: 508-862-4038 ` ' Fax: 508-790-6231
Property Owzier Must,
Complete and-Sign.Th.is Section
If Using- A Builder
I, I<G. f3.9 GC d C�C��.. , as Owner of the subject property :
hereby authorize Z_q.e:cj rem e e-. i)-v�r^2 to act ou my behalf,
in all matters relative to work authorized by this bading permit application for
(Addmss of Job)
nature of Owner. Date
Pent Name
If I'ro erty Owner is applying for perm tplease complete:the
'Homeowners License Exemption Form on' the reverse side.
r 'r�. Q:FORMS:OWhtERPERMISSION 1 {,,
Town of Barnstable R
pf rl*r �
o Regul'atoty Services
Thomas F. Geiler, Director
B-kRNSTk LF_
�P s6� A BuIldiag DIYIS1on
rED Tom Perry, Building Commissioner
200 Mairi•Strcet,_Hyannis MA.02601
WWW.to wn:b arnstab l e-ma.us
Office: 508-862-403 8 Fax: 508-790-6230
E[MaOV NER LICEM EXEM-PTION
Pleasc Print
DA TE:
JOB LOCATION:
number sirest village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRFSS:
city/town state zip code
715e et-u'rent exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hue who.does not possess a license,provided that the owner acts as
r
supcn isor_
DEFIRrITON OF HOIv1EOTi'NER
Person(s) who owns a pared 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 6ne 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 undcrsigncd"homeowner"assumes responsibility for compliance with the State Building Codc and other
applicable codes, bylaws, rules and regulations.
The undersigned "homeowner" certifies that.hr-Abc understands the Town of Barnstable BuildingDcpartent
mini um inspection procedures and requirements and that he/sbe will comply with said procedures and
requirements.
Signatisno of Homeowner
Approval of Building Offrcia]
Note: Three-family dwellings containing35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Constriction Control
HOMEOWNER'S EXEMPTION
.The Code states that "Any bomeovim r perfomring work for which a building permit is required shall be excmpl from the provisions
of this secti T.(Seetion i DMA -L ccn ing of construction Supervisors);provided tha t if the homeowner argages a po son(s)for hint to do such
work, that such HDmr-Dwner shall act as svpa-visor."
Many homeowners who use this exemption arc unawzre that they an assuming the respons)bililics of a supervisor(sec Appendix Q,
Rules&Regulations for Licensing Consbvction Supervisory,Section 2.15) This lack Df awarrness bfu n results in serious problems,particularly
when the homeowner hires unlicarsed persons- In this ease,our Board cannot proceed against the unliccnscd person as it r Du)d with a hcrnyrd
Svpervisor. The horhvowncr acting as Supervisor is u*nrutc)y respons)b)c.
To cnsttrt that the homeowner is fully aware of his/hv respons bi)itics, many communities rrquire, as part of the permit application,
that the homeowner certify that hdahe undcntErds the rt-sponnY)itics of a Supervisor. On the]an page of this issue is a form cur=t)y used b�
several towns. You may can t amend and adopt such a forr✓certifieation for use in your community.
Q:foTts:homccxcrnpt
or registration valid for individul�u e-only
L.
before the expiration date. If found return toulatio.n
I
' Office of Consumer Affairs and Business Reg 1
10 P::rk Plaza-Suite 5170.
Boston,MA 0
�r Not valid without signature
.,. .--
f"1�e �`
i Office o ousumer Af airs& usmess R �a«��,
HOME IMPROVEMENT CONTRACTOR
Registfation$ �164166 I
Expiration:= 9l1l2011 Tr# 288545
• i Type I~l dual
�?�
LAWRENCE DEVINE CARPENTRY
LAWRENCE DEVINE= 4` �r F
' `301 SIMONS NORROWS RD �� i
r7.1
. MASPHEE,MA02649; Undersecretary
'�- Niassuchuutts- Department of pUI)IiC S.ttcty
Board of Building o
Regulations and`Standard:s
Construction Supervisor License .
License: CS 54081
Restricted to: 00
LAWRENCE S DEVINE :t•
3
m z v
30
1
S
MO
NS NARROWS RD.
MASHPEE, MA 02649
Expiration: 9/20/2011
• ('u�miiiztiiphpi• -
Tr#: 8030
I r
aC) ll60o3
EM
XoFr►u>g� Town of Barnstable *Permit#
ti
Regulatory Services e
esbmarlrijronrrssr dote
.
�} tD O1 .0- -ARNSTABLE' Thomas F. Gciler; Director
-
Building Division 1'3���
Tom Perry, CBO, Building Comrnissioner �.�
200 Main Street, Hyannis, MA.02601
www.town.barnstable.ma.us
Office: 508-862=403 8
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION -.RESIDENTIAL ONLY
Not Valid wilbout Red X-Press Imprint
Map/parcel Number l C O
Property Address vc k e., , /7 V &. Ad.
residential Value of Work /C Minimum fee of$35,00 for work under$6000.00
Owner's Name & Address �er��,(eei139CC6iJc
a 3
Contractor's Name— ZaY`e^C.C O��o//✓rr �! Telephone Number S Oc a 76
�s Z..
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
YCh ck one: -
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name gg f
r
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
I
❑ Re-roof(hur.ricane nailed) (stripping old shingles) All construction debris will be taken to
❑ Re-.roof(hurricane nailed) (not stripping. Going over _ existing layers of roof) j
❑ Re-side
430 #of doors
[�Replacement Windows/doors/sliders. U-Value (maximum .35) #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 a Improvement Contractors License & Construction Supervisors License is
equir d:
SIGNATURE:
QAWPFILES\F0RMSlbuildingpermit formslEXPRGSS.doc
Revised Ml 10
M
x.- V.
d`a �L� •.
�r
le
.,
i -�j / fice,o onNmer A airasa n usiness egu anon
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement,Contractor Registration
Registration: 1(4166
` TYPe: Individual
# _ Expiration: 9/1/2011 Tr# 288545
LAWRENCE 'DEVINE CARPENTRY
LAWRENCE DEVINE £
301 SIMONS NORROWS RDA ;
Y
E M
MASPHE
ec; "' •; Update Address and return card.Mark reason for chap
Address Renewal E] Employment Lost
DPS-CAI sa 5OM-04/04-G101216 I
- ~ vrassachuticth Dep.irtmcnt.of Public Safety i- - —
License or registration valid for individul use only
Board of Buildin!o Re!gulation:s and Standards before the expiration date. If found return to:
Construction Supervisor License Office of Consumer Affairs and Business Regulation
License: CS 54081 ' 10 park Plaza-Suite 5170
Restricted to: 00 Boston,MA 0
LAWRENCE S DEVINE t
301 SIMONS NARROWS RD
MASfiPEE, MA-02649 _ ---
y ( .� Not valid without signature
Expiration: 9/20/2011
(' nunissiuncr Tr#: 803tT
The Conunoirweahli oflkfnssachuselts
- - Dep- artrrrernt of Industrial.Acciilents
— - Office of Invesfigafions
as
t m 600 Wash"inglon Street
Boston, JV4 02111
vvssIMrrrrr sgov1d'ia
Workers' Compensation Insurance AffidaNit: Builders/ContrzctorsJElectiici:.ins/Pltunbers
Applicant Information Please P1•int LegibIN
Nance (Busiiness/Orgmiza6omZndividrial): zXC__J-
Address:— �C' 1 �!� t] e S �f�✓/y+-J S /L�c
City/State/Zip: v Gi e.,_ Phone #: s3 7 7 6
Are you an employer?Check the appropriate boa.: Type of project(required):
1...❑ I am a employer with 4 ❑ I am a general contractor and I
loyees(full and/or part-time).* have hired the sub-contractors 6- ❑.New construction
2..IIa I am a sole proprietor or partner- listed on the attached sheet_ 7. ❑Remodeling
ship and have no employees These sub-con tractors have
8- ❑Detirolition .
working :for me in any capacity. employees and Have workers'
Y `9. ❑.$uittiim,g acidtio. •m
[No workers' comp-insurance # comp-insurance:
required] 5. ❑ We are.a corporation.and its 10.❑Electrical repairs or additions
3.❑ .1 am a.homeowner doing all work. officers.have exercised their I l,❑Plumbing repairs or additions
myself [No workers' comp- right of exemption per NMGL 12-❑Roof repairs
insurance required]T c. 152, §1(4),and.rve have no
employees. [No workers' 13.❑ Other
comp..mSurattce,required.]
'Any appticsvt thstchecks"box#1.aiust also 511out the section bel",sbawing theirworbers'compensmian policy infoawtian-
7 Homeowners who submit this affidavit indicating they are doing 91wcrk and then hire outside-contrRoors muv submit:anew"effidaj,'st indicating such
lContractors that check this:box must attacbed an sdditional sheet showing the'nsme of the sub-contracts-rs and state whether or not those eatitieshave
employees. Ifthe sub-•c.ontmctors:has=e employees,they.must provide their workers'comp.policy number.
I am au errtplay r tltrrt is pr avidirrg rtrowkers'carrrpettsation irrsrrm.rrc.e for rrty t?rrrplaJ ees. ffelow is fhe poliq ,and job site,
infora!ado t
insurance Company Name.-
Policy#or Self-ins-Lic.#: Expiration Date:
Job Site Address: vC_ Je City/Statezp:t oieh_ 'Ile .'t,4 '046 ?Z
Attach a copy of the w r•kers'compensation policy declaration page(slimiing the polic3,number and expiration date).
Failure to secure coverage as required under Section 25.A of h1GL c. I52 can lead to the imposition of criminal penalties of a
fine up to$1.,500.00 and/or one-year uuprisonment,as well as ci-vil 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.D.IA for insurance coverage verification.,
I do hem. y c�er under the ants and nrrfties of p,e u ry that the inforination pro-t4ded a bove is trite-aiid carrect.
Si tune: Date: Z(o
Phone#: S `� �' 7 -7 G GZc,�2
Q(j cial use only. Do riot}sprite in this area,io be completed by city or town.of cial
CSty or To-tim: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. C,ityffo-wn Clerk 4•Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#
6
pf1HE rp�
+ BARNSTABLE, +
ss Town of Barnstable
i679• 1�
�rFD MAy A
Regulatory Services
Thomas F. Geiler, Director
Building Division
Thomas Perry, CBO
Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable:ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
- --
�Q���eeA �J�i'CL� 1 U� as Owner of the subject property
hereby authorize - G,Cwftntp I IQJ, ,/ to act on my behalf,
in all matters relative to work authorized by.this building permit application for:
Z 7) 1 vG k el, 1'e- jc
(Address of Job)
ignature of Owner Date
-tint Name .
If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the ,
reverse side.
QAWPFILESIFORMSIbuilding permit formslEXPRESS.doc
Revised 072110
0 KE Town of Barnstable
Regulatory Services
" Ass..s Y Thomas F. Geiler, Director
� rns �,
an+g. Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office- 548-862-4038 Fax: 508-790-6230
----------------
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER"
name home phone N work phone N
CURRENT MAILNG 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,
and
bylaws, rules a 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,]27.6 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\building permit forms\EXPRESS.doc
Revised 072110
` )WLAT• FRBD A+190-147
�i FEE .$4.00
TOWN OF BARNSTABLE, MASS.
9b� O 17
s Ncgy*mber 14 74
is
THIS IS TO CERTIFY THAT A PERMIT IS HER GRANTED TO
' kG E g ed Paulat Canterviils
kn e,r7 0 ....
r. ... ..... . .. ...
ni M (PROPERTY OWNER) IADDRESSI
s �y _ Add to Z*rags
o °TO ........................._................ - __._...._.,_:..................... ............................_..._ _ ... ... ....—�ypp
,(BUILD( ,,rF IALTE0.1 - (REPAIR(
e pDDOO&W s l�ccessorp to dashing Add 18d s_ge_fte
.. _..........._._...... _....__..._—............ ..........
(TYPE OF BUILDING) _....... (APPROXIMATE BILE)
LOCATION 27 Tuckelm, k Road Centerville n,
__._._._.�
3j
-.S IeTR[ET D NUMBER( IVILLAGEI
Ow"r
NAME OF BUILDER OR CONTRACTOR -__...._...-.._.....__..__.._....._....
...__—_.._— _...�
A � $211000
CIA� b 'APPROXIMATE C T �__...__—.--_. ......_____.._......._.—..._.._.___—__--._...
�pg�eFp 'I HE BV AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN
OF BARN ABLE, REGARDING THE ABOVE CONSTRUCTION. 7
em oa
a s a D ..........................
_..__
(OWNER) (CONTRACTOR)
�. �.., [ J 1✓� :f 9
F tl D r� BUILDING INSPECTOR
.�J A Subject to Approval of Board of Health
S 1 � �
i
TOI,JN OF BARNSTABLE BULK RATE
COUNCIL ON AGING U.S. POSTAGE PAID
198 SOUTH STREET NON-PROFIT ORG.
HYANNIS, MA. 02601 PERMIT NO. 2
IN "7
`S
_ � J
Assessor's map and lot number/./.!" zfe.......
INSTALLE
.• J•`�t� -� IT T,.
Sewage Permit number ...... ....... ... SANITARY Co
THE. TOWN OF BARAYXULE
•
EARtSTADLE, i r"
"6 q .•�� BUILDING INSPECTOR
'OTfp ypY Ar•
' t
f
•� APPLICATION FOR PERMIT TO ........
....Gt2D'l� e......c4.!v..........
TYPEOF CONSTRUCTION ...... . 1C.4. .�.......................................... ........................................................
:P
� �..:.............................19 21
TO THE INSPECTOR. OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ......QC..?... .. . .......�W......................... ...................................... .. ............................
Proposed Use ...Cf9..C...J`1, e...... .......S1.41..✓10 ........................................
r v - /, r I
Zoning District .....�:......................................... .................Fire District ...Z�C./.4!(:�........l.f.l...........VS...�.C...�!.1..'e.......
..�,�.... ................Address .... �. ../..�1.��. .�!.Y'�t/U �c
Name of Owner ..... ............. Y•u...................
Name of Builder ..."CT .. e-U-4L�.................Address ...... l��?'Z!- .........................:......................:..........
Name of Architect ..Address -
Foundation
Number of Rooms .....Qi.U.(Z.-. ."......................................... �Q. .G................................rl ...........................
Exterior ....�"4"" 51). `.'G. ......................................Roofing .... t��f1141 ...SAY..�ll%...............................
Floors Cq4- rr14 Interior .....AZ).9/A
Heating ..A16, ................................................................Plumbing ./.vex! �../................................................................
Fireplace ...../V6.&4-'*..............................................................Approximate Cost 1.11,10'.0A2X.QP
Definitive Plan Approved by Planning Board ----------------_---------------19________. Area ....: �.�!
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
11v5 � 13 ►iG5
io a�/
S /
3 �
S�e e
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ............ ............... ................... ..............................
�
. Paulmt^ Fred
!
�
l�44�No -----.. Pannitfor ------.�������.. /
�
~w �
-------.---�........-----------.. '
< ' -
� Location ...........2.7. .Road____..
� --------. ���---------.. .
/
' 1
` Ovvne, ----—�r---
�� P�--��—a�—
� ---------- \
Type of Construction ........fX.Aft.......................
. -------.—.----------------' .
^ '
` ---'_---_. Lot __—_—______
� �^F1c�
^
' � 1
Permit Granted ---November..14....... y 74
� Date of Inspection ------------lP
.
� Date Cumu|e�e6
j - .
`
�
�
�
)? PERMIT REFUSED ^
. �
-----_--------------.. lA '
�
�
� --------------------------
� . .
/ -----.—~._---------..-------.. -
>
. ...-----------.—.----,.—.—.---.. `
,
-----~--^—''''-----'--^—^-----^
�
� .
`
| `
'
! Approved ................................................ lQ
^
---------------~.~—,—..—.--.— �
} ...............— ........................................................... .
`
Assessor's map and lot number A, Z. ......
v
Sewage Permit ...
FTHEr��♦ TOWN OF BARNSTABLE
Z 9►HH dDLE, i
°
109 BUILDING INSPECTOR
yPY tr•
APPLICATION FOR PERMIT TO ............fr�?.(r ?. ....... !r�, �J!�!.. .......................................................
TYPE OF CONSTRUCTION ..........Z�K tea. x-'
...........................19 e.............. ......
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location r/ter�'' �!.JC ?
ProposedUse ... ......... !„h. .l........` .. !. .............................................................................
Zoning District �' .............Fire District .... �'.✓fc -'..r.. ���.......V... ....... i/t . p......
........:...................................................
r sir v i,ram Y44 .� � G �(
Nameof Owner .....•...,.................. ...........................................Address .....,.........................
Name of Builder &..,,. ....................Address .......S.y4�:?............................................................
Name of Architect ................Address
Number of Rooms ..... ...............................................Foundation a,/.Yf/
............................................................
Exterior ....WAPe-/....�� Roofing .....t4�x7�1r�f�....� . �/l�U/. ...............................
-!. :5........................
Floors .....(20.,U 'i'f'/•.P .............Interior ..... f.11..��".r:�f�...................................................
...........................................................
Heating ... ...........................................Plumbing .. i�> -.!; ................................................................
p 4� ,L— .........Approximate Cost �Jr E�
Fireplace ...................................................... ....................................................................
....................
f
Definitive Plan Approved by Planning Board ________________________________19________ . Area ......`� k!..
i /.......................
Diagram of Lot and Building with Dimensions Fee ... ""....................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
i
-!!�/ - t
a _�y
xi
I hereby agree to conform to all the Rules and Regulations of.the Town of Barnstable regarding the above
construction.
Name .: �.�Ci..........-:V..............................
Paulat, Fred
No ..174.... Permit for ..add to �arag. .....
................................ . . .......*................. .........
Location 27 Tuckernu k Ro
.................................... .......... ...............
.......................... enterville.. ..... ....................
Owner ............Fred Paulat
Type of Construction frame
.................................
................................................................................
Plot ........................ Lot ................................
Permit Granted ........November 14 19 74
Date of Inspection ....................................19
Date Completed ......................................19
PERMIT REFUSED
................................................................ 19
...............................................................................
......................................................:.........................
...............................................................................
Approved ................................................ 19
...............................................................................
...............................................................................
f I I f I I � i t i t i i I t {� i• {. { I� I i . � i �. }, �' f i I j f�. t I � I I i �: ( � I i I I I - ,j� `I
I it � ( f 1 �,1 � �.. -. I ..i G.- i .. ,�� I 1 ! �4: � � I I, I ; •� �"'I'�_ 1-`` .L., , I -. I �
I � ;
I
w
f l a �� � '� _r
i I
I i I f' I f I
, i I ;
I - - I l
I �� ' I � I � I I � •�. i I - � f � ��_
I� -
'
I
; I I
I'
' I L
i t I I I �•
.
i
NlPt� �� 1 4 �� I � I I I I i I � I f ' -- - I I I ��
I
i 0P. I I 1 _ I I
,n � _. I I I I i
710 9 I` iU6 tf I
r
j � I I I I I' ' � i � , � ; I I � I I i I �• i j _ S� I �_
t X I
Po
i
I
4� �
In
I I I i I I I I II I
juS,j I 1 � pp410A, I I(,V j I I I j I I
I I I �
I'�,�C' I �.1C �ls '2 ! i i I I ''; ! I- i i _ ;� •j � i!, j G .I �j !! I i I � � � I--��
i i
I I e'UL�'��
I L
,
X
I
I
I
I I I � �' �, _ I �7� ✓��lj��� � � ' I I i I♦ r i ' I 4 I '. I { I � 1t I i j I ! _I i I
u 141 n
1 �
N
-r 0 ,rb f I I ! 1
I I o►�o' r ���S � /.. I� I � ; i i I � j I � ' � i � �'F�4�j � � i � �► !� I I I I �r� �� U c�1.,5� I I
G -� _ j � I 1 ► � �� ` I no � � �� �,�s �.�I I � � I i i� � I
- I i ' I I .�� '
I _
i1.
79"l
i
1
_ I I I � i � � I � I � � � � I
i
I � I I � � i j i j � I I
i I i ,
` F I I j � j I �- � I
� � I ��
I � I i I i � I I I l i I � ( �
I
i I � � ' � I � � � I I
I � � � i � � �
I � ► '
I � j i .
� � I
I I I
j , ► i j � � �
` I � i i I I I � I �
. _ I I � � .
, .
I I I
I I ; -
I I I �, � 1.
-�_ _
fi I � ` I I
I , �
_. _ _
y, j I
. � �. � _
1
� .I
I I i _ i
i
--�
. i
I ,: � _ .I
I � ( j � i � I �� G I
I, I � .. _
� I I 4
� i � �
I I j I I �j
. � � I
I I � I � I I
I i .I ' i I I � i i' 1 I �~ i
� � � -
' � I � � �
� I �"` ' �y � I � E i I � I
j _ j I - 1 a - ,�i 4',��1 I I � � 1
f � x�..�g _�?.s Q r 1 S�� I I I i' ' I i i I
v , �
I j I ri� ,,' �r,. �«�i}{j y .
� �� ,�rw
"�n �► I � j I I � I
..
I I
-�-------- -- -- -I- __.�__i�--- - - - i I i- .-i _, I - I � � I I _ _L.. I � � - I _ _
if
-7-T 7-
if I
Paz o 06,6D 1 1
if i
t 1 1 1 1-
-------------- -----------
MN
. .. . ........
I
I I• l � I I � j I I I ��-� '
I
t
I
-H4,
I
I
I I I
I
I
I I I I I i
I I I I
T I i I
I ,I
I
I
I t
I i •I I
I �
II
,
, r
I
I I �
, I I
I I I I I i , I I � � I •I ( I
I I
}}
I • � � I I I j. I � I
I ; -
� I
I i I I I
_-._- __ _ . . _._.. - -- -- - -..._ _. _ _ _----
f -TOE ELEV. = 1 00,9rj- PROVIDE PRECAST CONCRETE , i 2i
EXTENSION RISER WITH CONCRETE 5" DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS = 99.25 -100.00, �-'- � E:7;" „1�.L a ...' _�,� .- ._ >....
COVER TO GRADE OVER OUTLET FINISH GRADE OVER REMOVABLE COVER SLOPE @ 2% MIN. OVER SYSTEM 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
FINISH GRADE FOUND. EL.= 1 00.5' 7TANKEL.= 99 9'-100.1' FINISH GRADE OVER D-BOX= 1 OO.O' 4" SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE I METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE
@ - ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES.
-- _ _ .-- ---------.--_ - -- --_--_.-_- ___. 2" OF 1/8" TO 1/2" DOUBLE WASHED STONE
20"MIN. ACCESS COVER I _ 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
9" MIN. _- -- - __ � --
OF HEALTH AND THE DESIGN ENGINEER.
' (TYPICAL FOR 3) 36" MAX. 1 TOP OF SAS = 97.0$r PLACE RISERS ON ALL CHAMBERS
�- 36"MAX. TO 6" OF FINISHED GRADE 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL
EXISTING 4" 96 25' 36'MIN.
BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED.
CAST IRON PIPE I BREAKOUT EL = 96.75 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LES:
6" 3" 3" 9" } � ELEVATION = 96.75' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE S.
---- - T--- --- ---_- - 2" DROP MIN. 1 ; PROVIDE WATERTIGHT
10" 3" DROP MAX. JOINTS (TYP.) 0 0 0 0 0 0 THE LIN R IS NIL O B LESS THAN ANE LINER
BREAKOUT IS PLACE AT EELEVATION AST FIVE FEET FROM S.A.S. ANC
�•_ , 5 14" 97.65 4" PVC IN FROM O oo O o 0 5. SLOPE ALL SOLID PIPE AT 1.0 % MINIMUM.
SEPTIC TANK 4" PVC OUT TO
97 � LEACHING FACILITY I� T o00 � � � � � � � � � � o00 00 � � � � � o0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
90 ! o0 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN
48" OUTLET TEE 12" 2' o0 0 oo SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT
97.371/ MIN. \11 97.20 oo � BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEAL'
11.9' - 22"ZABEL FILTER o - -- 0 6" CRUSHED STONE p 0 0 0 0 0 0 o 00 0 o0 8. ELEVATIONS BASED ON ASSUMED N.G.V.D. DATUM OF 100.00'MSL
MODEL#Al801 HIP (GAS }� p - OBTAINED FROM A NAIL IN A PINE TREE AS SHOWN ON PLAN.
� 5 �� OVER MECHANICALLYi
BAFFLE ON BOTTOM) COMPACTED BASE 4.0 I I�.0 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTIOI
8.5'
6" CRUSHED STONE _ 40' 4.9` - 4-0'
THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SI-
OVER MECHANICALLY 5 OUTLET DISTRIBUTION BOX 42.0 (TYP.) AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY
✓� � � < 88.75' 12.9' DISCREPANCIES TO THE DESIGN ENGINEER.
' COMPACTED BASE TO BE INSTALLED ON A LEVEL STABLE , GROUND WATER ELEV=
BASE. FIRST TWO FEET OF OUTLET 94.25 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE
PROPOSED 1500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. I 4 - 500 GAL. CHAMBERS 5' MIN. ; STRUCTURES SHALL BE MADE WATERTIGHT.
LENGTH 10.5' WIDTH 5.66' DEPTH 5.58' CROSS SECTION VIEW I CHAMBER END VIEW 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR
-.1-. _ ,.` ; ,t �, �, �^ti. : , � �y.,6� �, s � ; ' �,�.�I.,4; �� , TYPICAL CHAMBER PROFILE 4 a� y�.. ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH
1 ` �3 c I '-... ri ,.-. I t ) j.f.�. F 1 T I
'� ° ti - �✓ - -- E I -�-' DETERMINATION FROM APPROPRIATE AUTHORITY.
NOT TO SCALE NOT TO SCALE NOT TO SCALE
--------
- ----_ -_ _. _ . 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
_ *j ��w t •' ��. '�• � ,• -,�, , t r ETA THEY SHALL WITHSTAND H-20 LOADING.
! y "** «, .• . � /jF * 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND
« + • * �" {�, /" FINES.
+ • # it'' .' .lf •' . AGENT:
� w. ' °,', ^� .,_.,.„ w „''►;; 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND
* * •* 'i a � ; * EVALUATOR: Samuel Philos Jensen UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF
► ` ' + •f ' i DATE: April 16, 2003 LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN
I "' *, '• * * rf• l' ` '° � "� « * "� t, COARSE SAND FREE FROM CLAY. FINES OR OTHER UNSUITABLE MATERIAL IN
•� ' ,rd , . * • w� TEST PIT* 1 ACCORDANCE WITH 310 CMR 15.255(3).
ELEV TOP = 99.75' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUL
' '� ' %� .; ,� "� " ' • SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
*/» • ,« • r f,w • r« ,� • �1 �� ELEV WATER = > 11' B.G.S.
• �#f•" + y�;,� w • * ,40 w • 16. PROPOSED PROJECT IS LOCATED WITHIN:
PERC RATE _ < 2 MIN/IN ASSESSORS MAP 190 PARCEL 147
"
W.., * r` . " " DEPTH OF PERC= 50" -68" 17. OWNER OF RECORD: ALAN BACCHIOCHI & JULIA PAULAT
1f10.Ca �; +«" }•y'kw! ADDRESS: 27 TUCKERNUCK ROAD
r : TEXTURAL CLASS: -- - 1 ._
` � /� • • `. CENTERVILLE, MA 02632
bl. �, + �• 0 99.75' 18. FEMA FLOOD ZONE C
F1
ti 98 a4 p �' \ ; I Sandy Loam AS SHOWN ON COMMUNITY PANEL# 250001 0015 C
N 1,, ,' :` I!; • "J A 1OYR 3/2 19. PLAN REFERENCE:
..,
�-''�' � � "° � l/ , � �'. „�; " � s � '• 1. PLAN ENTITLED " SUBDIVISION PLAN OF LAND IN CENTERVILLE BARNSTAf
4
OP.� D ( PP M. • * 8 99 09 . ' DATED JULY 2 96 SCALED AT SIXTY FEET TO
, . "
l * �,'' x 'i ALAN E. SMALL ET UX ' DA 2 1 8
T.� _ M-._
ti w PLAN BOOK 224 PAGE 87.
�� ( °" w. •• ; B-1 Sandy Loam
Qw ` "" , � r µ�-� 1OYR 5/6 20. DEED REFERENCE
�� .- �.w ,� + yr� 1. BOOK 12179 PAGES 102
,CvCj 1'aG t" n 1"r ' • " + �� �s�t. `L 9,S •� 20" 98.09'
• „ *w {' .✓ 21. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
EXlS`i^!G G!ti LINE 'f +r,��"-{• '. �► ��1�! .'�� : '^ Loamy Course Sand 22. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN,IS TO BE U:
LOCATION IS APPP,OXI'�1�.T" .._: ��_ /d •� • „ �r i, ': B-2
/`r * + , 10YR 4/6 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT 1$S E ANY LIAI
l4 6 X AND SHALL BE FIELD VFRIFIE-- r , • �. ►� • « o f
0 8 { ; _ r . • gyp". / *,� .�. 10-2010 Gravel / FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOS .
L �9 9 PRIOR TO SEPTIC INSTALL . f ' f j=, f%f� ��:,� ' •�f , :r' �:� •' 42
R� MAP 1 .f-� �- 1 - • yo
-
• 9 a5'
t
.
LOT 147 �� "� ' + � , • „
n, r r 50" 95.`59,
r 1 w r:• ,. x•r'9M iL_ r ..-. .. .'Pw'y�.._...r"'��•,,.ff iIF---- .1- :
VV_ PROPOSED 500 G3ALLON , i
r AREA = 1b,120 ± SO FT. (i SEPTIC r „ r 1 "`_i ._ I.. Perc C M-C Sand
CB/DH B.M. i ( 68„ 2.5Y 6/4 94.09'
(FND/HELD) 0`0 2'\ Nail in Pine Tree I
,,Into ��1 n Elev. = 100.00' LOCUS PLAN
Assumed No Groundwater
#27 I SCALE: 1" = 1000' { 132" Observed 88.75' 1
EXISTING ---
5-BEDROOM 1�15" TREE f '
DWELLING v �� I _ 4`bT '"Ci
r: Yr m. I
TOF = 100.95' /
EXISTING CONTOUR
\% , MAP 190
99 i� LOT 146 I 50 PROPOSED SPOT GRADES
/ �. NUMBER OF BEDROOMS (ASSESSORS) 5
12"TREE l N/F PROPOSED CONTOUR
CONC. H i GOODMAN i NUMBER OF BEDROOMS (DESIGN) 5
I �' 1 15"_TREE DESIGN FLOW 110 GAUDAY/BEDROOM I _.._._._
PATIO 10" TREE
' N 10E0 5t: 10 CI r; MCP'' r TOTAL DESIGN FLOW 550 GAUDAY I �� i/ EXISTING OVERHEAD UTILITIES
i
r y= 1 •3A.5 ! DESIGN FLOW X 200 % 1100 GAUDAY j
._....... ....... lr' ................... EXISTING WATERLINE
MAP 190 w c -M
LOT 148 `k ���i'� USE PROPOSED 1500-GALLON SEPTIC TANK -- GAS
N/F - 1 o REE ` EXISTING GAS LINE
HAMBLETON 12"TREE A2 :;.;. ! ( TEST PIT LOCATION
92 SEE .....: / ,� 8"TREE I
} o ! INSTALL 4 - 500 GAL. CHAMBERS ! PROPOSED 1500 GALLON SEPTIC
EXftiTING CESS::'00_S -
> 4 / r ( 4" SOLID SCHEDULE 40 PVC PIPE
To EF Per ^rD AND SIDEWALL CAPACITY
12" TREE 12"TREE FILLED CLEAN SAND �06 `��, `,RE DISTRIBUTION BOX
10"TREE (LENGTH + WIDTH) (2) (2' HIGH) (.74 GPD/S.F.) = GAUDAY
1r
` 6" TREE (42.0' + 12.9') (2) (2') (.74 GPD/S.F.) = 162.4 GAUDAY G 500 GAL. LEACHING CHAMBER
12" TREE _ 12� MAP 190 I
LOT 23 BOTTOM CAPACITY
N/F I I
COURTEAU
( LENGTH x WIDTH ) (.74 GPD/S.F.) = GAUDAY
(42.0' x 12.9') (.74 GPD/S.F.) = 400.9 GAUDAY
I� MAP 190 i REV. DATE BY APP'D. DESCRIPTION
P 1 PROPOSED SEPTIC SYSTEM
DISTRIBUTION BOXN/F TOTALS: i + PREPARED FOR:
PERKINS ± ALAN BACCHIOCHI
J
PROPOSED 500 GALLON
LEACHING CHAMBERS TOTAL NUMBER OF CHAMBERS: 4 I - LOCATED AT
i TOTAL LEACHING AREA: 761.2 SQ.FT.
i
TOTAL LEACHING CAPACITY: 563.3 GAL./DAY i ( 27 TUCKERNUCK ROA[
CENTERVILLE, MA 0262
RESERVED FOR BOARD OF HEALTH USE I j
{ - SCALE: 1 INCH = 20 FT. DATE: M
{ ( OF I I 1I 2I 40
URCJOHN I PREPARED BY:
o CHURCHILL a
JR. JC ENGINEERING, INC
CMl (
r I
' No.
41W' i 5 ROUNDHILL BLVD
I EAST WAREHAM, MA 02
508.273.0377
_._--- � ITS p I AN __- - -----
Sy Drawn By: DFS Designed By: DFS Checked By: JLC