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r Town of Barnstable
Regulatory Services
` BAIMMBM Thomas F.Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Sec on
If Using A Builder
as weer of the subject property
hereby authorize to act on my behalf,
in all matters relative to work autho\edbythis b g permit.
(Address of )
**Pool fences and alarms are t e respons' ility of the applicant. Pools
are not to be filled or utilized fore fence is ' stalled and all final
inspections are performed an accepted.
Signature of Owner Signature of Applicant
Print Name Print Name
Date
QTORMS:OWNERPERMISSIONPOOLS 6/2012
Town of Barnstable
Regulatory Services
9snRt�rnsrE� Thomas F.Geiler,Director
i6
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
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: ? —7-
JOB LOCATION:- 1 I�tc-t 11
number street village
=`HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS: S71 5 ' `C'0-7
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.
DEFINTrION 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 under *geed"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws es and plations
The ersigned" ifies he/s derstands the Town of Barnstable Building Department minimum inspection
pr es and reat he e wi c mply with said procedures and requirements.
ture of Homeo Approval of Buildi g
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.
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc
Revised 053012
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant-to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defin gas"an individual,partnership,association,corporation r other legal entity,or any two or more
of the foregoing en in a joint enterprise,and including the le g g g� J rp g gal represe flues of a deceased employer;or the
receiver or trustee of an dividual,partnership,association or other legal en ty,employing employees. However the
owner of a dwelling house aving not more than three apartments and who esides therein,or the occupant of the
dwelling house of another o employs persons to do maintenance,co ction or repair work on such dwelling house
or on the grounds or building purtenant thereto shall not because of su employment be deemed to be an employer."
MGL chapter 152, §25C(�also s that"every state or local licens' g agency shall withhold the issuance or
renewal of a license or permit to erate a business or to construct uildings in the commonwealth for any ,
applicant who has not produced ac eptable evidence of complianc with the insurance.coverage required."
Additionally,MGL chapter 152, §25C states`Neither the commo ealth nor any of its political subdivisions shall
enter into any contract for the performan of public work until acce le evidence of compliance with the insurance
requirements of this chapter have been pre nted to the contracting thority."
Applicants
Please fill out the workers'compensation affida it completely,b checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),addre s(es)and ph e number(s)along with their certificates)of
insurance. Limited Liability Companies(LLC)or L ted Liab ity Partnerships(LLP)with no employees other than the
members or partners,are not required to carry worke compe ation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this a davi ay be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Als be ure to sign and date the affidavit The affidavit should
be returned to the city or town that the application for the it or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regar ' g the law or if you are required to obtain a workers'
compensation policy,please call the Department at the n r 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 print legibly, e Department has provided a space at the bottom
of the affidavit for you to fill out in the event the O$ e of Investig lions has to contact you regarding the applicant-
Please
be sure to fill in the permit/license number w 'ch will be us as a reference number. In addition,an applicant
that must submit multiple permit/license applicaao in any given ye ,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Si e Address"the ap 'cant should write"all locations in (city or
town)."A copy of the affidavit that has been offici lly stamped or mar ed by the city or town may be provided to the
applicant as proof that a valid affidavit is on file f future permits or li nses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining license or pemut not lated to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)s d person is NOT requir to complete this affidavit.
The Office of Investigations would like to thank ou in advance for your coo eration and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax n er:
The Co onwealth of Massachusetts
Depattnaent of Industrial Accidents
Office of%yestigatiolls
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 1-977=MASWE
Revised 4-24-07 Fax#617-727-7749
www.mass,govldia
. . . -- ----
The Commoniveahh of Massachusetts
Depart ent of lndusa ial Accidents
Office of lmwt gations
b, 600 Washington Street
.Boston,MA 02111
wnnv.mass govIdia
Workers' Compensation Insurance Affidavit:Builders/Contractor.ectricians/Mi tubers
Applicant Information `` Please Print Legibly
Name(B��tion&dividnal):
hddress:
3v '--12--/ ZFsfs
City/State/Zip:
Are you an employer?Check the appropriat Type of project(required):
L❑ I am a employer with Vve
6- ❑New construction
employees(fulland/orpartAime).* redthesuh-comt<sctois.2_❑ I am a sole proprietor or partner- n dze attached sheet. �- ❑Remodeling
ship and have no employees These sob contractors have 8. ❑Demolition.
workingfor.me in an capacity. employees and have workers'
y apa. ty_ 9. ❑Building addition
[No workers' comp-insurance comp.insurance.t
5. ❑ We area corporation.and its 10-❑Electrical repairs or additions
mod) officers have exercised 1 . Plumbing repairs or additions
am a homeowner doing all work h id their L
❑Plb g p ,
€[No workers'camp- right of exemption per MGL
VI 12-.❑Roof repairs
insurance required.]b c. 152, §1(4),and we have no
employees_[No workers' 13_❑Other
comp-insurance required.];
*Any sppticmn that checks boat#1 mast also fill out the section below showing their workers'conpensadonpolicy infbr>�
I Homeowners who submit this affidavit indicating they are doing all woadc and then hire outside contractors rust submit a new affidavit indicating suc1L
(Contractors thst check thi s boat must attached an additional sheet showing the name of flie sub-can ors and state whether ornot those entities have
emplayees. If the sabtoutraRors have employees,the}'must provide their workers'comp.policy number.
I am art employer that is providing workers'compensation insurance for irty employees Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins-Lic #: Expiration Date:
Jot}Site Address: Ctty,'StatelZt-
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 crirnireal penalties of a
fine up to$1,500.00 and/or one-year sonment,as well as civil penalties in flee form of a STOP WORK ORDER and a fine
of up to250_(}0 y garnst the tar_11!�d4�that a c of this statement may be forwarded to the Office of
IuvesEigations flte IA for cecov �on
I do hereby fy rider the ' s andpenalfi s o it at the information pratrided above is taste and correct
Si tore: �\
Phone
Qfficial use only. Do not write in this area,to be completed by city or town official
City or Town: PermitUcense#
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.Cit lTown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone-#•
6
oFt „ Town of Barnstable *Permit#
Expires 6 mon fr 'ss
Regulatory Services Fee
RM I 1 Thomas F.Geiler,Director
prED MA'S A
Building Division
JUL 312013 Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508
®�� �� ���� �� �'-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Map/parcel Number
Not Valid without Red X-Press Imprint
Property Address Acc ilo
❑Residential Value of Work$ ,,a ,Sa 0 Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole-proprietor
�`am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
Re-side
Lj'Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance is permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: rop Owner must sign P er wner Letter of Pergussion.
A py of the Home Imp ovement Co tractors Licen &Construction Supervisors License is
r quired.
SIGNATURE:
QAWPFILESTORMS ding permit fomns\EXPRESS.doc
Revised 060513
c �
•�--�,.1-• -�6
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 3 Parcel�Z1 Application #
Health Division Date Issued
Conservation Division � / Application Fee �.
Planning Dept. Permit Fee TZ
Date Definitive Plan Approved by Planning Board Ir— p%(ca,
Historic - OKH _ Preservation / Hyannis .
Project Street Address S-7 1 S
Village �� ( �� ��p
Owner >n.S Address S7 1 S
Telephone 71 1 N2H 2 RCS G
Permit Request C-\C 1wi �' - Z�X•(G
O'L7 • w c lc��s?�.�z .
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s pportinocurentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King' Highway ❑Yss ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (slft) w r-
IV Y
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review #
Current Use _ Proposed Use
1
APPLICANT INFORMATION
1 (BUILDER OR HOMEOWNER)
c�� -,�n
NameTelephone
S1G�'1 Number
A - 1
Address S� !" �"' ` ° License #
Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
e /je2,
SIGNATURE DATE ho
'f _} FOR OFFICIAL USE ONLY
_ )APPLICATION#
F
} DATE ISSUED
,t
MAP/PARCEL NO.
1
` ADDRESS VILLAGE
' OWNER
d
DATE OF INSPECTION:
-FOUNDATION--,
FRAME
k INSULATION
FIREPLACE
s
ELECTRICAL: ROUGH FINAL
'.; PLUMBING: ROUGH FINAL
,z GAS: ROUGH FINAL
;i FINAL BUILDING
f ,
DATE CLOSED OUT
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
Boston,MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information \` Please Print Legibly
Name(Business/Organization/Individual):
Address: `►� � `
City/State/Zip: q-,c,,.t naX r-j� -L Phone#: _2S I H Vi
Are you an employer?Check the appropriate bog: Type of project(required):
1.El am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers'comp. insurance comp. insurance.
t 9. ❑Building addition
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
yself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors 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.
I am 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 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$1,50.0.00 d/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 �against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations o eIA for insurance coverage verification.
I do hereby c Underthepains and penalties of perjury that the information provided above is true and correct.
Si ature: Date: //Q / 3
Phone#: 1 C{Z<-( 19-&6
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle-one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an' dual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house ving not more than three apartments and who resides therein,or the occupant of the
dwelling house of another wh employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building ap urtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also sta s that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to op rate a business or to construct buildings in the commonwealth foi'any
applicant who has not produced acce table evidence of compliance with the insurance. required."
Additionally,MGL chapter 152, §25C( states"Neither the commonwealth nor any of its poll ' al subdivisions shall
enter into any contract for the performanc of public work until acceptable evidence of co lance with the insurance.
requirements of this chapter have been pre nted to the contracting authority."
Applicants
Please fill out the workers' compensation affid it completely/bemitted
cking th oxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),ad ss(es)and pmber along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or imited Liaartne hips(LLP)with no employees other than the
members or partners,are not required to cant'work s' compe ' ante. If an LLC or LLP does have
employees,a policy is required. Be advised that this ffidavit miffed to the Department of Industrial
Accidents for confirmation of insurance coverage. o besu ' and date the affidavit. The affidavit should
be returned to the city or town that the application forth permense is being requested,not the Department of
Industrial Accidents. Should you have any questions reg ding or if you are required to obtain a workers'
compensation policy,please call the Department at then erelow. 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 1 'bly. a Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office f Investig 'ons has to contact you regarding the applicant.
Please be sure to fill in the permit/license number whi will be used a reference number. In addition,an applicant
that must submit multiple permit/license applitmdo any given year, eed only submit one affidavit indicating current
policy information(if necessary)and under"Job Si Address"the appli t should write"all locations in (city or
town)."A copy of the affidavit that has been offic' lly stamped or marke y the city or town may be provided to the
applicant as proof that a valid affidavit is on file or future permits or licens . A new affidavit must be filled out each
year.Where a home owner or citizen is ob a license or permit not rela d to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc. said person is NOT required to mplete this affidavit
The Office of Investigations would like to th you in advance for your cooper a 'on and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and f number:
Th commonwealth of Massachusetts
D partment of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
TO.#617-727-4900 ext 406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 4-24-07
www.mass.gov/dia
i
Town of Barnstable
Regulatory Services
g ry
Thomas F.Geiler,Director
&659. . � 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
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: ,- n`_ L
JOB LOCATION: ��I S �'M�`Y) SA-
street village
-HON1EowN> 7_i ��YS l 6l 72"I G 37'�
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,,Rrovided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section
109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws, s d regulations.
The dersi ed"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection
pro ure d requirements and that he/she will comply with said procedures and requirements.
of omeovmer
pproval 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 persons)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.
C:\Users\demUil\AppData\Local\Microsoft\Wmdows\Temporary Internet Roes\Content.0udook\QRE6ZUBN\EXPRESS.doc
Revised 053012
t
o�TME Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
art' 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
Prop Owner Must
Complete a d Sign This Section
If Us' A Builder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work autho ' ed by this buil g permit
ddress of Job)
**Pool fences and s are the responsibility o the applicant. Pools
are not to be filled o utilized before fence is install and all final
inspections are perf rmed and accepted.
Signature of Owner ' Signa.ture of Applicant
Print Name Print Name
Date
Q:F0RMS:0WNFRPj6WSSI0NP00IS 62012
_._...._..... gip"DISTRIBUTQRS LLC PAGE 01
Q5,=15/2E03 11:16 508-435-4127 ALL STIST
LADDER ENCLOSUP-M.
i
• I
•
♦
•
t i ♦ •i
�►..ality by de ion
Q5/15/2 +03 11:16 508-435-4127
SCP DISTRIBUTORS LLC PAGE 02
LADDER RNELO UE SP=CIFICA�TIONS
• Vinyl Works Canada manufactures the Model 4941.E Ladder Enclosure to meet or-
exceed BOCA/ANSI/NSPI code requirements for ladder enclosures
• The Mddei.494-LE Ladder Enclosure is manufactured using maintenance free resins for
years of worry-free enjoyment
• The enclosure Is packaged in one box with the side frames and gate fully assembled to
Make for a quick and easy Installation
• The Model 4 s as an optional Side panel which can be ordered
separately. a 4'"Side 1 attached to the rear of the unit to eliminate access when used
with a pool nstalled access to the pool is totally secured
• Spring-loaded,self-closing,self-latching and lockable gate hardware is packaged with the
unit.The unit can be locked to deny access when not In use
• The gate on the enclosure is to open outward as per the installation Instructions
The side frames and the gate come pre-assembled using vinyl lattice which Is smooth,
has no sharp edges and has opening spaces of 1"square
• The side frame height of the ladder enclosure.measures 48"from the top of the top rail to •
the bottom of the bottom rail. The installation instructions specify that the space beneath
the bottom rail to the ground not exceed 2"
The width of the unit measures 33", large enough to accommodate most a-frame ladders
• The overall depth of the enclosure measures 40"
• The gate measures 29"wide
• The gate height'neasures 57=/"from the top of the top rail to the bottom of the bottorn
rail.When installed.on the unit,the gate latch measures 58"from the ground
• The redder enclosure installation instructions specify that the unit be placed directry
against the pool wall, surrounding the entrance ladder, to eliminate any opening between
the pool and the enclosure. Brackets are included with the hardware to secure the unit to
the top rail of the pool to keep it in place
• We recommend that the ladder enclosure be used with elthir of our Pool Fencing heights
..so that the entire pool can be enclosed for greater security. The use of our Closure IGts
d0bles you to join the Pool Fencing directly to the Ladder Enclosure leaving no open
areas to the swimming pool
• Vinyl Works Canada reserves the right to change or alter the manufacturing
_ specifications within the specified c 9de requirements. if there should be any questions
:..;:. . regarding this or any of our products please do not hesitate to contact our customer
service department at toll free i-877-VINYL WK
REMEMBER NOTHING REPLACES PARENTAL SUPERVISION
Town of Barnstable Geographic Information System.
June 26,2013
317022
#3676::_ 317024
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DISCLAIMERS:This map is for planning purposes only. It Is not adequate for legal Map:317 Parcel:081 � (�
boundary determinatlon or regulatory Interpretation. Enlargements beyond a scale of Owner.ST PETER,STANLEY E Total Assessed Value:S415200 Selected Parcel
T=100'may not meet established map accuracy standards.The parcel Ilnes on this map w E
ere only grephlo representations of Assessor's tax paroels.They are not brae property Co Owner:%JOMNSTON,DANIEL B 8 Acreage:0.99 acres Abutters
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13 DCI 41' 5 AT T $ goTIOM ! EI WLMLS
IMETown of Barnstable *Permit# s U6 f,=
i Exptres,6 onths rom issue date
Regulatory Services Fee a
anxrr omas F.Geiler,Director
9 6�- ESS PERIVII Building Division
FEB 4 ZOO$ Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
TOWN OF BARNSTABLE www.town.barnstable.ma.us
Office:.508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint -
Map/parcel Number./ /
Property Address 131'" lY74-A 19 9k—
sidential Value of Work 0 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address
Contractor's Name t S Telephone Number �Q c> .b
Home Improvement Contractor License#(if applicable) f e) 2 c)
❑Workman's Compensation Insurance
. Checlrone:
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name /Vl 0--L
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
0'Re-roof(stripping old shingles) All construction debris will be taken to 72' V
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)
*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 th me Improvement Contractors License is required.
SIGNATURE:
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
Revise020108
�1
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
Boston, MA 02111
wM b� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leguibly
Name(Business/Organization/Individual): S14,
Address: c� �✓c� i
City/State/Zip: 94tzJsfA6A;_ 6LL 3 6 Phone.#: 3 b
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
e oyees(full and/or part-time).* have hired-the sub-contractors 6. ❑New construction
..2:ET I am a sole proprietor or:partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees 'These sub-contractors have g, ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y P tY• $ 9. ❑Building addition
[No workers'-comp.insurance comp.insurance. 10. Electrical repairs or additions
required.] 5. ❑ We are a corporation and its ❑ P
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.EJ-1 of repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.] .
3 *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.
tContractors 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. l
Insurance Company Name: ,/t/
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address 3�/c 6zL 4 ,q City/State/Zip:/& AX O 3 ® .
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 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
of up to$250.00 a day agains a violator. EL—advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA r-insur v e ve 'fication.
I do hereby certify er the pans a �ena ' �ofpe�rjury that the information provided above is true and correct.
Si afar : Date:
Phone#: `3 3�YAV
Official use only. Do not write in this area,to be completed by city or town official
.City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as "...every person in.the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds 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 licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall .
enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number 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 may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth o€Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, NIA 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
Regulatory Services
BAMSTABM
MASS. Thomas F.Geiler,Director
16.19.
0. 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
'i
Property Owner Must
Complete and Sign This Section
If Using A Builder
I (S v�� O-�U ��--� as Owner of the subject property
a � kwo—hereby authorize"7 es N ✓ � to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
p 7-0 Kv 0
ig a of er Date
S
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:O WNERPERMISSION
i
Town of Barnstable
�oFz�lDwti
y�P Regulatory Services
r BARNSTABLE. Thomas F.Geiler,Director
9 MA93. g
1639. Building Division
TED MA'I A .
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER I,
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to
be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes bylaws,rules and
PP � Y � regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a forn✓certification for use in your community.
Q:forms:homeexempt
i l
✓lie �an�rea�ruuec�l/ o���/laaaaclucaeG7a { _._ ._._.. _. ., r. _:.;.. i
" Board of Building Regulations and Standards •
License or registration valid for individul'use only
HOME IMRROVEMENT CONTRACTOR be:ore thii expiration date. if found return to ".
{ _ P
Registration 100390. ai
P
Board of BuildingRegulations and St �dar.,ds
g
j OueahUurton Place Rm 1301 6/1E ration6/2008 S Type Individual Bo�ton,;11'Ia.02lOS
STURGIS S i
Sturgis St.Peter '
65 Cindy Lane/P O.'Box 2.f„ -
3aPn�tab0�630,, -N t v id without signature
r
i.
Ft„E, Town of Barnstable *Permit#1� 3�
Expires 6 months from issue date
,,,�,� , : Regulatory Services Fee
30AThomas F.Geiler,Director
9�� i639, A10
rEo '' Building Division
Tom Perry, Building Commissioner X-PRESS, PERMIT
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 JUL � 3 2004
gam; 508-790-6230
EXPRESS PERMT APPLICATION - RESIDENITAWW-BARNSTABLE
Not Valid without Red X-Press Imprint
Map/parcel Number
�4; ST
Property
e Address l -j ,
/
(S-Presidential Value of Wo
Owner's 1,jarne&Address
-�
Co
ntractor's Name .t � Telephone Number Z, J�/��b
Home Irnp �®
rovement Contractor License#(if applicable) ® J /
Construction Supervisor's License#(if applicable) O
❑WorlcEI
' mpensation Insurance
e;
a sole proprietor
the Homeowner
❑ I have Worker's Compensation Insurance '
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit R;Re-roof
t eck box)
(stripping old shingles) All construction debris will be taken
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)
"Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: P erty O er mu i Property Owner Letter of Permission.
ome ro t C tractors License is required.
1 }
Signature
Q:Forms:expmtrg
Revise053003
tH�T Town of Barnstable
o� -Regulatory Services
as F.Geiler,Director Thom
1619• A` Building Division
pT�D � TomPerry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma,us
Fax:--508-790-6230
Office, 508-862-4038 '
_ Property Owner Must w� _
Clorriplete and Sign This.Section y =
- If Using A Builder
as owner of the subject property
_. � 1 .S . ` �' to act on my behalf, -
-hereby authorize -
in all
matters relative to work authorized by this building permit application for;
'3115 izAe_ bA
(Address of Job)
®
Sid afore Date
of awn
Prsnt Name
55157
BUOK.7r755 PAGE 320
QUITCLAIR DEED
I, RARL F. NcHRIDB, JR., of Hain Street (Route 8A), Barnstabla,
Barnstable County, Nassachusetts,
for consideration paid, and in full consideration of TUBE THOM1D JWW
and a0/100 (93,f00.00) DOLLARS,
grant to StANLRY B. Sr. PETER and FRANCES H. ST. PETER, husband and wife
as Tenants by the Entirety, both of Hain Street (Route 6A), Barnstable,
Barnstable County, Haesacbusatts,
i.
with QUITCUIX COYBHANTS,
the land in Barnstable, Barnstable County, .Haesachusette, more
particularly bounded and described as follows; i
HASTBRLY by land now or formerly of Stanley H. St. Peter, at ux,
thirty-five and 00/100 (35) feet;
SOUTHERLY by land now or formerly of Stanley E. St. Peter, at ux, i
fifty-seven and 00/100 (57) feet;
9BSTERLY by land now or formerly of Richard Lamb, at ux,
thirty-five (35) feett and,
NORTHERLY by land of Earl F. HcBrids, Jr., fifty-seven and 00/100
(57) feet,
Said land to be conveyed consisting of 1,995 square feet, is a
portion of land formerly owned by Stanley E. St. Peter and Frances H.
St. Peter, as more fully described in a deed to them dated xay 21, 1965
and recorded in the Barnstable County Registry of Deeds in Book 912,
Page 184.
i
Page 1 of 2 Pages
I
s=7755 rAu 321
For my title, see deed to me from Stanley B. St. Peter and Frances
H. St. Peter, dated September.18, 1986, and duly recorded in the j
Barnstable County Registry of Deeds in Book 5312, Page 084.
YITIM my hand and seal this Seventh Uth) day of November, 1991.
Bar cBride, —
COMMUALTH OF NASSACRDSBTTS
Barnstable, ss. Date: November 7, 1091
Then personally appeared the above-named EARL F. NcBBIDH. JR., and
acknowledged the foregoing instrument to be his free act and deed,
before me,
/40
Notary Public
Xy Commission Expires;
DEEDS REG 01
9 v -BARNSTAM
11/14/91
I-TAX 10.z6
MCK. 10:26
393,5A®00 15.33
EXCTbE TAX
Page 2 of 2 Pages
RLUAD NOV 14 9
i
i
BARNSTABLE COUNTY
REGISTRY OF DEEDS
A,�T./RRUUE COPY,ATTEST
JOHN F.MEADE,REGISTER
7 5-
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TOV N t.,F
EASEM�iNT511-1
-_
THIS GRANT OF EASEMENT is made by ST. PETER FAMILY REALTY TRUST,
ROMANIE ABRAHAM,TRUSTEE, under a Declaration of Trust dated October 22, 2001,
and recorded with the Barnstable County Registry of Deeds in Book 14351, Page 313, of
3715 Main Street, Barnstable, MA 02630 (the Grantor")
TO LETA FULGINITI' fp L3705 Main Street, B rnstable, MA 02630
WHEREAS, the Grantor is the owner of a certain parcel of real property located at 3715
Main Street,Barnstable,Barnstable County,Massachusetts,as more particularly described
in a Deed to Grantor dated October 22, 2001, recorded with the Barnstable County
Registry of Deeds in Book 14351, Page 320 (the "Burdened Premises");
WHEREAS,the Grantee is the owner of a certain parcel of property located at 3705 Main
Street, Barnstable, Barnstable County, Massachusetts, as more particularly described in
a Deed to the Grantee dated August 14, 1992, recorded with the Barnstable County
Registry of Deeds in Book 8216, Page 27 (the "Benefitted Premises");
WHEREAS,the Grantor is the owner of a garage structure located mainly on the Burdened
Premises but having approximately 68(sixty eight)square feet of the structure located on
the Benefitted Premises;
WHEREAS,the Grantor has agreed to grant an Easement for the benefit of the Benefitted
Premises on and over a certain portion of the Burdened Premises consisting of .a
rectangular piece of land containing approximately 565(five hundred sixty five)square feet,
and the garage thereupon, plus an additional 2(two)foot buffer zone on all sides, located
as shown on the attached Exhibit"A", in that area designated as the"Easement Area"-.
NOW,THEREFORE,for consideration of payment of THREE THOUSAND AND 001100
($3,000.00)DOLLARS,the receipt of which is hereby acknowledged,the Grantor hereby
grants to the Grantee the following Easement:
1. The Grantor does hereby grant and convey to the Grantee, her heirs,
successors and assigns with quitclaim covenants, for the benefit of the
Grantee,jointly and severally,the perpetual exclusive right and easement in,
on, and over and across the Easement Area. The Easement granted
includes the right to perform at the Grantee's sole cost and expense
reasonable maintenance and repair work in and over the Easement Area,
including repair and maintenance of the garage structure.. The Easement
Area is not to be used as an accessory dwelling or any other use prohibited
by the Town of Barnstable.
2. The purpose of this Easement is to allow Grantee use of the garage
structure as well as a small buffer zone around the portion of the garage
located on the Burdened Premises for access to and maintenance of the
garage.
3. The Grantee hereby releases to the Grantor and permanently waives all right
of the Grantee or any person claiming by,through, or under the Grantee in
or to the Easement Area or any other portion of the Burdened Premises
except for the Easement granted hereunder.
4. The Grantee agrees to indemnify and hold the Grantor harmless from and
against all costs, claims, expenses, damages, including personal injury and
property damage,and all liabilities of any nature whatsoever incurred by the
Grantor as a result of the granting of this Easement and the use thereof by
the Grantee.
5. As used herein, the Grantor and Grantee shall include their legal
representatives and shall be binding upon and enure to the benefit of the
parties hereto.
EXECUTED under seal this day of March, 2013.
ST. PETER FAMILY REALTY TRUST
Romanie Abraham, Trustee Leta Fulginiti
STATE OF
March , 2013
On this day of March, 2013, before me, the undersigned notary public,
personally appeared Romanie Abraham, Trustee as aforesaid, proved to me through
satisfactory evidence of identification, being(check one): ❑ or other state
or federal governmental document bearing a photographic image, ❑oath or affirmation of
a credible witness known to me who knows the above signatory, or❑ my own personal
knowledge of the identity of the signatory, to be the person whose name is signed on the
preceding or attached document, and acknowledged to me that he signed it voluntarily for
its stated purpose.
Notary Public:
My commission expires.
COMMONWEALTH OF MASSACHUSETTS
Barnstable, ss March I`j , 2013
On this 15`r" day of March, 2013, before me, the undersigned notary public,
personally appeared Leta Fulginiti, proved to me through satisfactory evidence of
identification,being(check one): or other state or federal governmental
document bearing a photographic Image,❑.oath or affirmation of a credible witness known
to me who knows the above signatory,.or❑my own personal knowledge of the identity of
the signatory, to be the person whose name is signed on the preceding or attached
document, and acknowledged to me that she signed it voluntarily for its stated purpose.
Notary Public:
My commission ex .
&Za SUSAN L. PROVENCHER
Notary Public
COMMONWEALTH OF MASSACHUSETTS
My Commission Expires
October 14. 2016
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Map 317
_' Parcel 81 v. N Lot 2
91.93'
2 N 8774.30" W STREET ADDRESS 13715 MAIN STREET(ROUTE 64)
ASSESSORS MAP 317 PARCEL&
OWNER: ST. PETER FAMILY REALTY TRUST
DEED REF.: SKK, 14351 PG. 320
PLAN REF.: PL BK. 282 PG 28 LOT 1
TOWN OF BARNSTABLE ZONING
BY-LAW
ZONE : RF-2
SETBACKS: ! CERIFY THAT 70 THE BEST OF MY PROFESSIONAL
FRONT = JO' KNOWLEDGE, INFORMATION AND BELIEF THE DWELLING
SIDE 15' -%HOWN HEREON CONFORMS 70 THE HORIZONTAL SETBACKS
REAR = 15' OF THE ZONING BY-LAW FOR THE TOWN OF BARNSTABLE
PROPERTY LINES SHOWN HEREON
WERE COMPILED FROM AVAILABLE ��y�aFM4,-09c
PLANS OF RECORD AND VERIF70 �r°2 TERRY EASEMENT PLAN
ON THE GROUND. ANN IN
VVARNER
No 38721 BARNSTABLE, MASS
THE DWELLING DEPICTED ON 7H1S
PLAN WAS LOCATED ON THE GROUND SCALE: 1'=40' MARCH.19, 20I3
BY SURVEY ON AUG 24, 2012 AND
E:(ISTS AS SHOWN AS OF THE DATE 1 TERRY A. WARNER, P.L.S.
OF LOCAnON. 3�Z /3 22 LONG ROAD
HARWICH, MA. 02645
THIS PLAN IS FOR PLOT PLAN (506) 432-8309
PURPOSES ONLY.
THIS PLAN IS VOID /F NOT
STAMPED AND SIGNED IN RED. 0 20 • 40 80
PROJECT NO. 12-196EASE
PAISTABLE REGISTRY OF DEEDS
COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE.) SS SUPERIOR Court
BACV2012-00548
LETA FULGINITI.
V.
ROMANIE ABRAHAM, M A r rl
TRUSTEE OF THE,
ST. PETER FAMILY.REALTY TRUST
SUBPOENA
TO: Town of Barnstable
Building Inspector
Paul Roma
200 TV am Street
Hyannis;MA 02601 3
Greetings: You.are hereby commanded in the name of the Commonwealth of
Massachusetts to appear before the Superior Court at Barnstable in the County of
Barnstable at Barnstable on the 8'�day of November at 2 o'clock PM and from day to day
thereafter until the action hereinafter named is heard by.said Court, to give evidence of
what you know relating to.an action then and there to be heard and tried between.
You are further required to bring with you any and all building and other
documents relating to the properties at'3715 Main Street,Rte.6A owned by St. Peter and
3705 Main Street,Rte. 6A owned by Fulginiti.
Hereof fail not as your failure to appear as required will subject you to such pains and
penalties as the law provides. .
Please contact Attorney Ddvid R. Harsch with anyquestions at 508-539-2328
Dated November 2,.2012 ► /"�
raid M. DeSalvatore
�.� ary Public/Justice of the Peace
'i►
17
p
Town of Barnstable
Regulatory Services
9 MAS&BARMABLA�' Thomas F.Geiler, Director
Eo;p. Building Division
Thomas Perry, CBO
Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstabte.ma.us
Office: 508-862-4038 Fax: 508-790-6230
November 6, 2012
Attorney David R. Harsch
16 Sunset Strip
Mashpee, MA 02649
i
RE: 3715 & 3705 Main Street, Rte 6A Barnstable
Dear Attorney Harsch:
It has come to our attention that you are no longer representing the address
referenced above. Please contact this office in writing as soon as possible to
confirm.
Respectfull
Tho as erry, CBO
Building Commissioner
t
3715 (St. Peter)Main St., Barnstable; 3705 (McBride/Fulginiti) Main St., Barnstable
GARAGE
1986-February: 3715 Main=.99 acres; 3705 Main=.31 acres; both lots are in RF-2 zone;
both lots are non conforming i.e. less than required 1 acre; both lots are developed
1986-July 10: McBride(3705) appeared before Zoning Board of Appeals for a two car
garage to be built on his property; at that same meeting, he asked to have the application
withdrawn; request was granted
1986-September 6: McBride(3705) applied for building permit for a two car garage;
application included a site plan showing the garage's having proper 15'side and rear set
backs on an 1890 sq. ft. rectangular bump out in rear of lot
1986-September 16: St. Peter(3715 Main) sold to McBride(3705 Main) 1995 sq. ft. of
land from 3715 Main at same location as proposed garage; this act intensified the non j
conformity of 3715; St. Peter was to build garage for McBride; garage was built
199 1-November 7: McBride (3705) sold same piece of land-(1995 sq. ft.)back to St.
Peter(3715);garage now straddled property line—some on McBride's, most on St.
Peter's: both non- conforming properties continued to be non-conforming
1992-September 15: Leta Fulginiti bought 3705 Main; garage straddled property line
2012 Estate of St. Peter(3715) appeared before Old King's Highway to obtain Certificate
of Appropriateness to demolish garage; Fulginiti objected stating that she owned the
garage and had been paying taxes on it; case went to Superior Court but was withdrawn
2013-April 18: Easement agreement between St. Peter estate and Fulginiti in which:
a) St. Peter Estate owns garage
b) easement is 565 sq. ft.
c) cost of easement is 3,000 dollars
d) easement is in perpetuity
e) dates changed,but not initialed
IS THERE ANY ZONING VIOLATION ON ONE OR BOTH OF THESE
PROPERTIES
CAN BUILDING PERMITS BE ISSUED FOR EITHER PROPERTY?
IS THIS A VALID EASEMENT AGREEMENT?
DOES IT NEED ZBA SANCTION?
F
BOOK$3V RGE 064 1
68610 °
WE, STANLEY E. ST. PETER and FRANCES H. ST. PETER. husband and wife,
as tenants-by the entirety, both of Main Street (Route 6A). Barnstable,
Barnstable County. Massachusetts. for consideration paid of THREE THOUSAND
FIVE HUNDRED AND 00/100 ($3,500.00) DOLLARS. grant to EARL F. McBRIDE, JR. v
of Main Street (Route 6A), Barnstable, Barnstable County, Massachusetts.
with QUITCLAIM COVENANTS, the land in Barnstable, Barnstable County.
Massachusetts, more particularly bounded and described as follows: S
EASTERLY by land of the Grantors, thirty-five and DO/100 (35) feet; C
'. • . SOUTHERLY by land of the Grantors, fifty-seven and 00/100 (57) feet; �
WESTERLY by land now or formerly of Richard Lamb, et ux, thirty-five \Z_
(35) feet; and
'. NORTHERLY by land of Earl F. McBride, Jr., fifty-seven and 00/100
(57) feet.
Said land to be conveyed consisting of 1.995 square feet, is a portion of v L �J
land owned by the Grantors, Stanley E. St. Peter and Frances H. St. Peter, 11--
as more fully described in a deed to them dated May 21. 1955 and recorded
® in the Barnstable County Registry of Deeds in Book 912, Page 184, to which
deed reference can be made for Grantors' title: w
EXECUTED AS A SEALED INSTRUMENT THIS DAY OF SEPTEMBER, 1986.
Stanley t. Peter Frances H. St. Peter
COMMONWEALTH OF MASSACHUSETTS L
Barnstable, ss. September A,- 1986 I(�
Then personally appeared the above-named STANLEY E. ST. PETER and
FRANCES H. ST. PETER and acknowledged the foregoing instrument to be their
free act and deed, before me, N,
.1,.......... '.o%
hOTA r rn
=�- Notary ublic
`�,,: My commission expires: -�9-i999
R���FCED sEP zz 86
BARNSTABLE COUNTY
REGISTRY OF DEEDS
A TRUE COPY,ATTEST
JOHN F.MEADE REGISTEq
Lk 27303 P9259 229 ID.6
r -=13-21313 a 03 :05P
00 000 23 -uoJ iiT.'8 •aa3 MASSACHUSETTS STATE EXCISE TAX
9f75Zt. •r oQ 9221 :TI1:i. BARNSTABLE COUNTY REGISTRY Of _DEEDS
Wdgo:20 e 210i-8I-'io :epa Data: 04-19-2013 a 03:05Qm
S0330 3O A&S1931 AINfl0-,i 31aHiSHIB2 Ci1T: 1336 Do,_T: 22906
XVI 3siox'3 I.Tjq= 37adiSNUVa. Fee: $10.26 Cons: Qt000.00
EASEMENT
THIS GRANT OF EASEMENT is made by ST. PETER FAMILY REALTY TRUST,
ROMANIE ABRAHAM,TRUSTEE, under a Declaration of Trust dated October 22; 2001,
and recorded with the Barnstable County Registry of Deeds in Book 14351, Page 313, of
3715 Main Street, Barnstable, MA 02630 (the "Grantor")
TO LETA FULGINITI of 3705 Main Street, Barnstable, MA 02630
WHEREAS, the Grantor is the owner of a certain parcel of real property located at 3715
Main Street,Barnstable,Barnstable County, Massachusetts,as more particularly described
in a Deed to Grantor dated October 22, 2001, recorded with the Barnstable County
Registry of Deeds in Book 14351, Page 320 (the "Burdened Premises");
WHEREAS, the Grantee is the owner of a certain parcel of property located at 3705 Main
Street, Barnstable, Barnstable County, Massachusetts, as more particularly described in
a Deed to the Grantee dated August 14, 1992, recorded with the Barnstable County
Registry of Deeds in Book 8216, Page 27 (the "Benefitted Premises");
WHEREAS,the Grantor is the owner of a garage structure 1ocated mainly on the Burdened
Premises but having approximately 68 (sixty eight)square feet of the structure located on
the Benefitted Premises;
WHEREAS,the Grantor has agreed to grant an Easement for the benefit of the Benefitted
Premises on and over a certain portion of the Burdened Premises consisting of .a
rectangular piece of land containing approximately 565(five hundred'sixtyfive)square feet,
and the garage thereupon, plus an additional 2 (two)foot buffer zone on all sides, located
as shown on the.attached Exhibit "A", in that area designated as the "Easement Area".
NOW, THEREFORE, for consideration of payment of THREE THOUSAND AND 00/100
C ($3,000.00) DOLLARS„the receipt of which is hereby acknowledged, the Grantor hereby
grants to the Grantee the following Easement:
1. The Grantor, does hereby grant and convey to the Grantee, her heirs,
successors and assigns with quitclaim covenants, for the benefit of the
Grantee,jointly and severally,the perpetual exclusive right and easement in,
on, and over and across the Easement Area. The Easement granted
includes the right to perform at the Grantee's sole cost and expense
reasonable maintenance and repair in and over the Easement Area,
including repair and-mg[ntenwoe'-��age structure. The Easement
Area is not to be used as an accessory dwelling or any other use prohibited
by the Town of Barnstable. . .
Bk 27303 Pg260 #22906
2. The purpose of this Easement is to allow Grantee use of the garage
structure as'well as a small buffer zone around the portion of the-garage
located on the Burdened Premises for access to and maintenance of the
garage.
3. The Grantee hereby releases to the Grantorand permanently waives all right.
of the Grantee or any person claiming by, through, or under the Grantee in
or to the Easement Area or any other portion of the Burdened Premises
except for the Easement granted hereunder.
4. The Grantee agrees to indemnify and hold the Grantor harmless from and
against all costs, claims, expenses, damages, including personal injury and
property damage, and all liabilities of any nature whatsoever incurred by the
Grantor as a result of the granting of this Easement and the use thereof by
the Grantee.
3. As used herein, the Grantor and Grantee. shall include their legal
representatives and shall be binding upon and enure to the benefit.of the
parties hereto.
i
i
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Bk 27303 Pg261 #22906
EXECUTED under seal this day of-hlareh,
ST. PETER FAMILY REALTY TRUST
Romanie Abraham, Trustee Leta Fulginiti
STATE OF �� U
Ll a I`1 CDC lJ llfeFi , 2013
On this day of Mare h, 2013, before me, the undersigned notary public,
personally appeared. Romanie Abraham, Trustee as aforesaid, proved to me through
®rsatisfactory evidence of identification, being (check one): Vdrivees license or other state
_; or federal governmental document bearing a photographic image, ❑oath or affirmation of
a credible witness known.to me who knows the above signatory, or❑ my own personal
knowledge of the identity of the signatory, to be the person whose name is signed on the
preceding or attached document, and acknowledged to me that he signed it voluntarily for
its stated purpose.
+�'+j,,:,. _ 11ti 11131E
•• Pn6ik,B�d�Allr
4mrw Me Notary P lic:
inNanri My cammis�ion expires:
COMMONWEALTH OF MASSACHUSETTS
Bamstable, ss March `J , 2013
On this day of March, 2013, before me, the undersigned notary public,
personally appeared Leta .Fulginiti, proved to me through satisfactory evidence of ,
identification, being (check one): or other state or federal governmental
document bearing a photographic image, ❑oath or affirmation of a credible witness known
to me who knows the above signatory,or❑my own personal knowledge of the identity of
the signatory, .to be the person whose name is signed on the preceding or attached
document, and acknowledged to me that she signed it voluntarily for its stated purpose.
Sim -q
Notary Public:
My commission e '
SUSAN L. PROVENCHER
+f, Notary Public
�• `' 'eV ,.. COMMONWEALTH OFMASSACHUSETTS
00
,� �•�.• � r,,;.y�. •: My Commission Expires
October 14. 2416
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a 82�140 E
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Easement Area �i.
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Lot 1
N 87'24'4.0" W
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42,869E S.F.
0.98E AC.
Map 317 N
Parcel 81 � N Lot 2
91.9,3'
Z N 8724.30" W 1 STREET ADDRESS j0715 MAIN STREET(ROUTE 6A)
ASSESSORS MAP J17 PARCEL81
OWNER. ST. PETER FAMILY REALTY TRUST
DEED REF: BK. 14351 PC 320
PLAN REF:: PL 8K. 282 PG 26 LOT 1
TOWN OF BARNSTA'BLE ZONING
BY-LAW
ZONE : RF-2
SE7SACKS : I CER7TFY THAT 70 THE BEST OF MY PROFESSIONAL
FRONT = 30' KNOWLEDGE, INFORMA77ON AND SEUEF THE DWELLING
SIDE = 15, SHOWN HEREON CONFORMS TO THE HORIZONTAL SE7BACKS
REAR = 15' OF THE ZONING BY-LAW FOR THE TOWN OF BARNSTABLE
PROPERTY LINES SHOWN HEREON
WERE COMPILED FROM AVAILABLE � *alta9c
PLANS OF RECORD AND VERIFIED °2 TERRY yG� EASEMENT PLAN
ON THE GROUND. ANN w IN
WARNER
THE DWEZiJNG DEP/CTED ON THIS No.38721 BARNSTABLE, MASS
to
PLAN WAS LOCATED ON 7HE GROUND SCALE 1'-40' MARCH 19, 201-3
BY SURVEY ON AVG 24, 2012 AND I
EXISTS AS SHOWN AS OF THE DATE TERRY A. WARNER,P.L.S
OF LOCA770N. #/3 22 LONG ROAD
t/ARWICFI, MA. 02645 .
THIS PLAN IS FOR PLOT PLAN (508) 4J2-8309
PURPOSES ONLY.
7HIS PLAN fS VOID IF NOT
STAMPED AND SIGNED fV RID. 0 20 .40 80
PROJECT NO. 12-196EASE
DRISTABLE REGISTRY OF DEEDS
#401
318-026 \ � - 318-039 _ F'
` #370 - " :1es 300 318 336
318-052 �' \. �,i: ` -.318-041
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ACCESS COVERS MUST BE WITHIN INSPECTION 9" MINIMUM, INVERT ELEVATIONS : DESIGN CR I TER I A : GENERAL NOTES :6" OF FINISH GRAD PORT 3' MAXIMUM COVER
FIRST 2' TO INVERT AT BUILDING: 101.3 DESIGN FLOW:
BE LEVEL INVERT IN SEPTIC TANK: 100.55 4 BEDROOMS AT /10 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION
INVERT OUT SEPTIC TANK: 100.3 BEDROOM EQUALS 440 G.P.O. OF THE SEWAGE DISPOSAL SYSTEM ONLY.
4 D/AM PIPE CLEAN SAND BACKFILL INVERT /N DIST. BOX: 100.22
AROUND AND 2" OVER CHAMBERS INVERT OUT DIST BOX: 100OS NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS
l 0/.3 100.3 /00.0 3.3' . .
SET. SEE S 1 TE PLAN.
100.55 '� GAs 100.22 °a 99.98 :f99.7 INVERT IN LEACH CHAMBER: 99.98BAFFLESEPTIC TANK REQUIRED:
Alm 16 6 OUTLET 32 INFITRATOR QUICK 4 PLUS BOTTOM OF LEACH CHAMBER: 99.7 440 G.P.D. X 20OX - 880 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS AND
D-BOX STANDARD LP CHAMBERS /N BED FORMATION ADJUSTED GROUND WATER: 94.7 SEPTIC TANK PROVIDED: 1500 GAL. 'MIN. MAINTENANCE OF THE SEPTIC SYSTEM SHALL
1500 GAL OBSERVED GROUND WATER: 90.8 CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL
SEPTIC TANK 6- CRUSHED STONE OR a BOTTOM OF TEST HOLE *I: B9.8
COMPACTED BASE SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS.
_ ADJUSTED I NDEX WEL L A l W 247. ZONE 8 DESIGN PERC RATE ( 5 MIN/I NCH
PROF I L E :NOT TO SCALE GROUNDWATER, EL-94.7 JULY 2012 READING-24.56'. ADJ-3.9' SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER
EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFF 1 C OR GREATER
OBSERVED 440 GPD / 0.74 GPD/SF - 595 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF WI TH-
cRovtinwATER. EL-90.e STANDING H-20 WHEEL LOADS.
UP/3/!69
PROVIDED: 32 I NF I L TRA TOR QUICK 4 PLUS
STANDARD LP CHAMBERS. 128'x 4.73 SF/FT 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR
- 605 S.F. x 0.74 - 448 GPD APPROVED EQUAL.
l L0 UT� SOIL TC S l 6. SEPTIC,TANK AND D-BOX SHALL BE REINFORCED
l �'� P I T DA TA PRECAST CONCRETE OR APPROVED POLYETHYLENE.
i' INDICATES _� INDICATES BOTH SHALL BE WATERTIGHT, D-BOX SHALL BE WATER
/ PERCOLATION = OBSERVED TESTED FOR LEVEL WHEN THERE IS. MORE THAN ONE
TEST = GROUNDWATER OUTLET.
\ \
\ \\ \ \ S 82'S/ '4p- 100.6 TP s/ Ps137I9 TP +►2
\ \ \ 2- • ioo.2 7. BEFORE CONSTRUCTION CALL "DIG-SAFE',
HOR 1 ZON TEXTURE COLOR HORIZON TEXTURE COLOR 1-888-D 1 G-SAFE AND THE LOCAL WATER DEP T.
-------- 0' 9.9.8 0' 99.8 FOR L OCA T ION OF UNDERGROUND UT I L I TIES.
\ \ 4-TREE A LOAMY IOYR A LOAMY IOYR
I 24• REE
\ \ �� o o SAND 2/2 SAND 2/2
r rwi - 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE
\ \ \ 1� �--- --_TP�2 -� �! 2\' REE / 22- - - - - - - - - - - - - - - - - - - - - 9,8.0 20' - - - - - - - - - - - - - - - - - - - - 98. 1 DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION
1
\\ BM. CORNERS\,�EP \3 \ 0' REE LOAMY IOYR LOAMY IOYR
EL•104.02 \ i SAND 6/4 SAND 6/4
\ \ s� sb/L aEaovaL \ R SCHEDULING THE
. . .... .... ....
OF THE SYSTEM TO ALLOW FOR OF
\ \�-" 36' - - - - - - - - - - - - - - - - - - - - 916.8 40' - - - CONSTRUCTION INSPECTIONS
\ \ � q-eox - :::•.:•:•:•::•:':::::•:�::�:�: -:-•:::: sEk� NOTE /0. +l0 .0 - - - - - - - - - - - - - - - - - 96.5 TRUCT
.... .... ...
C I MEDI UM 10YR C I MEDI UM IOYR
\ \ 4:. SAND 6/6 SAND 6/6
• • -• •• •••• •-•• •••• '••• • ---9. EXISTING CESSPOOLS TO BE PUMPED DRY, REMOVED
.. .... .... .... ...
\ \ 4/oo./ 1 48-
o• ::� / 32 IWILTRATOR QUICK 4 1N THE AREA OF THE NEW SYSTEM AND BACKFILLED
Jkr / PLUS STANDARD LP CHAMBERS WITH SAND.
\ o FRONT :. : 1500 GALLON / O 1�\ oQ_ ?�
V
\ \ o ROAM SEPTIC TANK
\ 4i \\ m sEEYVOTE II. ` CES kofts t / . /0. ALL UNSUITABLE MATERIAL (A 6 B HORIZONS)
\\ h \\ / ENCOUNTERED BELOW THE INVERT OF THE LEACHING
!2-T E _
\ 'o \ oFFlcF 36 A i O 1 �� _ g FACIL I Tr TO•BE REMOVED FOR A--b13T4NCE_iOf-5- -_._ _
\ h N \ ,- LIVING - \ \ \ / l08" 90.8 /08" 90.8
ROOM \ i - \ 4j r =
BATH \ i f f Qo 6 � WITH NTITLE SEPLACED WITH SAND 1 N ACCORDANCE
2 \ c /y
\ \ /oi.a I20" 69.8 /20"
PORCH - .:lrl.:,. S,EWFR; k I NE; TA 04, SLEEVED.a 1,0 FE T F WATR, ,t
DATE: AUGUST 20. 2012 LINE WITH A LARGER DIAMETER PIPE.
12' R E / �T TEST BY: STEPHEN HAAS
3 APLG \ -`/ WITNESSED BY: DONALD DESMARAIS 12. ALL SEWER LINES ARE TO BE VERIFIED. EXISTING
\\ \ SHOWER \\ / _ PERC RATE: C 2 M/N/I NCH INVERTS MAY NEED TO BE RA I SED TO MEET THE
PROPOSED INVERT ELEVATION AT THE DWELLING.
SEWER OUTLET AND CESSPOOL FOR THE KITCHEN AND
SHOWER ARE UNKNOWN AND MUST BE LOCATED. PUMP
AND FILL CESSPOOL. REROUTE SEWER L I NE TO THE
PROPOSED SEPTIC TANK.
64
LOCUS OIZv�/
C8/0H FND
& �
S tE P T I C SYSTEM D E S
GARAGE o
t \` LOCUS MAP 3715 MA l N STREET . MAP 317 . PARCEL
I � BARNS TABL E . MA .
� BATH N
T BEDROOM LEGEND PREPARED FOR
L O T I ■ CB CONCRETE BOUND S T P E T E R
42. 869* S.F. aEoaooM BEDROOM -W .EMI LY TRUST WATER L 1 NE _
O HYDRANT SCAL E / 20 AUGUST 30 . 20 12
G GAS L/NE
SECOND FLOOR PLAN OHW- OVER HEAD WIRES S T E P H E N A H A A S
-0 LIGHT POST
12/f.03' -E- UNDERGROUND ELECTRIC LINE ENGINEERING , I N C
N -T- UNDERGROUND TELEPHONE LINE 8T 24'40"W 9
-CTV- UNDERGROUND CABL EV I S I ON LINE �l �=�` Y a r rno u t h p o r t?3 Route 7
M A 02675
+40.4 SPOT ELEVATION ��� l
//` � ( 508 ) 362-8 1 32
40....... EXISTING CONTOUR
( 5 O 8 ) 3 6 7- 1 6 9 1
0 10 20 40 40 PROPOSED CONTOUR
JOB NO: 12- 125
�- -- - - r --- - - - ----- - -_._-__T_ -- -