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0061 TELLEGEN TRAIL - Amnesty & MULTI-FAMILY
'� �� , . a s u r w µ I� f h t 7 r + 1 �: ., '14 ""�', fira., a,,r,9'n,g` 7± 4`, �"+ " �" ,ps R,:c� +..Er - -.c-:-. _ .. ...:. cif• .. .. .Fi: ".:, 1'��. ,r ;�'. "' .xw •�; - z'+.. ,Q ,. pF,F' ':.-�, Y •at. ., -w �, .. r ,, ?-», Y,. ;�, ,.,r} _... r."�,' G ' .., i� .,,.:aii£. -, S saw '.r' ..k�.:'.l'L .. ?.".r C 5:��.. a, ,..r i'Y =F •:Z a 6 w �, a. , r n c�'? ,f` o p c..,__ ,:''.'�.. �'¢ ,,\ 1? ~1.'_ ,�. a a- ,a,i.-. A. x.�. 't., k .I, �.,.: ,,t': x'. •-.: r.- *', :_...;,�:�•' B' s•' Ai �e, .,• ,� 'x...t v' :�! ,. _,.,.,`'-';=�+ 4 "', � P... .. +i°�' ' d'..a �. ,,.y.• .-n. .zG. _ a f"";. ,v # 4 n; i e `�. +F .,r� ,yt,. r : d ,;� x r d n X y r.' J '6 7h e ❑ h�:a ' Wfy> s " err a t rr - ' - ' ayh,.,. _ a, Qy I -.- ,„' f ,�, v,- , •. tip:. s ., .,. , , s . i i,' h ' i.' �'x r.� �, ��fi f., �r 5�� r. C ate / 4: 4,. C 1 -. 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T. ^, iS „' n. �, s i ,. ��; .n,. �+ f< , .:. ., ,... , . ,r _ t a 5-' Y V• a :, f,., „ .. ,. , a a „+'E C' 1 yi 7, :f. P f i S +1 !' y A : , + D ,.. .-. .. p , .. i. .1"-. - TOWN OFSARNSTABLE BUILDING PERMIT APPLICAT ON ' Map Parcel Application # —0— b 6 Health Division Date Issued `�3"�� r Conservation Division Application Fee Planning Dept._ Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis / a l-rG� Project Street Address f (eq 6K -TV-(a Village W(,& Owner u,<i��' WA Address Telephone Permit Request 4,1 V t hA a k, +-`54%I " V b o& 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 supporting documentation. Dwelling Type:'Single Family ] Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _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 ❑ �aJ�L�9NG DEFT Commercial ❑Yes 460 If yes, site plan review# MAR Current Use Proposed Use 2$ 2011 TOWN OF BARNSTABLI APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Jim Tele hone Numb r p e Address W dfill License#61 Home Improvement Contractor# �� 6 Email Qal �vrc CDGI Gli'L q wl• Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING OM THIS PROJ TNVILLBETAKENTO SIGNATURE DATE �� L c FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r � 4y GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT: ASSOCIATION PLAN NO. y� The Commonwealth of Massachusetts , Department of Industrial Accidents 1 Congress Street, Suite 100 ,s Boston, MA 02114-2017 ww>~.mass.gou/dda lVorkers, Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH T$E PERMITTING,A,LITHOP4TY. Anplicant Information Please Print Le ibl Name (Business/Organization/Individual): CA ? (k 6 V v Address: 1 City/State/Zip: AVYU0(,t,' Phone#: Are you an employer?Check the ppropriate box: Type of project(required): I 1 am a employer with A;5 employees(full and/or part-time).* 7. ❑ New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.(No workers'comp.insurance required.) 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑ Demolition 4.71 am a homeowner and will be hiring contractors to conduct all work on my property, 1 will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions S.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance,; 13.Q Roof repairs JK6.0 we are a corporation and its;of#icers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.(No workers'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. 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, Insurance Company Name: �A( Policy#or Self-ins.Lic.#: C�'i �j q Q Z Expiration Date: Job Site Address: bl ?it � _gm. m City/State/Zip: '4A Attach a copy,of the workers' comphnsation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 andlor.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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un 1 ains and pe a of perjury that the information provided ab ve is true and correct. Si ature: / 1 . Date: Phone#: Official use only. Do not whte 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 S. Numbing Inspector 6.Other Contact Person: Phone#: .............. ....... Massachusetts Oeparlmenl of Pvi;Illo Safety Board 61 SkIlIdIng Re&Aflons and Standards License: 06,100ge8 Construction SuporvIsor, HENRY E OAS-810Y. 0 SHED ROW WEST YARMOVII-I 00 will%, Expiration: WnmIssloner St Off Ice of Consumer Affairs and Business Regulation 10 Park PlaZa -' Suite 5170 Boston, Ma usefts 02116 I Home Improve eRE.N...,tractor Registration Type: Corporation Cape Cod Insulation, Inc Registration: 10567 IS Reardon CircleExpiration: 12/14/2018 So. Yarmouth, MA 02664 i.e. Update Address and return card, Mark reason for change. 15 20M-06/il Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only Tr�.'Pq corporation before the expiration date. If found return to: atlon Expirallom Offloe of Consumer Affairs and Sualne egulation 7) 12/14/2018 10 Park Plaza-Suite 5170 j; Boston),MA 02UI t Cape Cod Insu Henry CassIdY 18 Reardon CIro' So.Yarmouth, ...... cr -Undo.reecretary Ignoture-not -�� CAPECOD•27 DEATON CERTIFICATE OF LIABILITY INSURANCE DATa(MMIOD/WYY) . 7129/2016 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement s PRODUCER Ro are&Gray Insurance Agency,Inc, 877 816.2166 South Dennis,MA 02660 mall ro era ra ,com INSURER(9 AFFORDING COVERAGE NAIC N INSURER A I Peerless Insurance Company INSURED INSURER8188fe Insurance Company 39464 Cape Cod Insulation,Inc, INSURER c,Enduranoe American Specialty Insurance Company 41718 18 Reardon Circle INSURER olAtlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER E I INSURER F I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: ' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY,PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE'TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LT TYPE OF INSURANCEJ=ma POLICY NUMBER M D M A X COMMERCIAL GENERAL LIABILITY LIMITS EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE M OCCUR CBP8263063 041011201$ 04/0112017 $ 100,000 'l .n MED EXP(Anyoneperson) $ 61000 PERSONAL&AOV INJURY $ 11000,000 GEN'LAOOREOATE LIMIT APPLIES PER: GENERALAOOREGATE $ 2,000,000 X POLICY Q JECT ❑L0C" PRODUCTS•COMPIOPAGO $ 2,000,000 OTHER:AUTOMOBILE LIABILITY $ B D $ 1,000,000 B ANY AUTO 8232707 COM 01 04/0112016 04/01/2017 BODILY INJURY(Per person) $ ALL OWNED x SCHEDULED AUTOS AK OSWNED BODILY INJURY(Per accident) $ 'X HIREDAUTOS X AUTOS 100 E $ X UMBRELLA LIAS rd 000VA $ ^ EACH OCCURRENCE $ 2,000,000 C EXCESS LIAR CLAIMS•MADE EXC10008836001 04/0112016 04/01/2017 AGGREGATE $ DED X RE ENTION 10,000 WORKERS COMPENSATION Aggre ate $ 2,000,000 AND EMPLOYERS'LIABILITY UTE OFFICERIMEMBEREXCLUDEO?ECUTIVE YIN N/A WCE00431902 0813012018 0813012017 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) lie describe undel E.L.DISEASE•EA EMPLOYEE $ 1,000,000 DES RIFT ION F OPERATION below E.L.DISEASE•POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORO 101,Additional Remarks Sohedulo,may be stUohed If more apace Is required) Workers Compensation Includes Officers or Proprietors, Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, CLEAResult,Eversource and National Grid are listed as Additional Insureds on this policy on a primary,non•contrlbutory basis, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVIOONS, AUTHORIZED REPRESENTATIVE ®1988.2014 ACORD CORPORATION. 011 rinhfe raearvoA . ice... Tow.n of Barmtoble Ro0ato y Services �. I�ie�ard'�:.Scali,Dir�cta� A� di# DbUion Tomka",BwlCmg C mmaisdame iM Maio week-Hyannis,MA 02601 www.town.baras"leaaams OM= 508-862-4038 Far: 508-790-M30 Pioexty Ow=Must Com plewe =.4*5igu This Section If Usjnps�.B�de ._ . ...... ... ..__�....__.. _ _ S ,is Owner-of fihe-awfort pmpmy hw*wmhoT= to=t,on.mybebW, in al matters rmkfem to work awhoiized W this binding pemut application for CO Y, v, 11 "Poolfe&a and slaioas a���es�n�is�of �Ff,ant'.Isools �e ia�t•to.l?e.f 0r u 'beftare fe�ace is ims• i: ,d awow-lions ke•pe&tme4-and.acceptel '.� Owner's I nature $ na eof•Apoic= PribtName Pliut Nam QIKff=WWNEKlVAbUMNPOOlS I to 60 to Town of Barnstable 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-16-3144 Date Recieved: 10/24/2016 Job Location: 61 TELLEGEN TRAIL,CENTERVILLE €; Permit For: Building-Solar Panel-Residentiala 1 �' X-- Contractor's Name: JOSEPH M WYLDCHIRICO State Lic. No: CS-093115 Address:. Seekonk, MA 02771 Applicant Phone: (401)574-6684 F;3 toe, (Home)Owner's Name: WYTRWAL,MARCIA JOCELYN Phone: (508)367-1669 `' ' (Home)Owner's Address: 61 TELLEGEN TRAIL, CENTERVILLE,MA 02632 Work Description: Installing 37 PV solar panels on roof,9.80kw Total Value Of Work To Be Performed: $35,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Joseph Wyld-Chirico 10/24/2016 (401)574-6684 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $35 000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $228.50 _.1 ;.... .......... Total Permit Fee Paid: $0.00 TH�I� �S�NOWT�A�PE�RMIT , S�231/b IKE Town of Barnstable *Permit 09 0 —/C Expires 6 months from issue date yT Regulatory Services Fee Fir ( BABNSTABLE, v Mass Richard V.Scali,Director i639• �� ArfO�p Building Division o PER Tom Perry,CBO,Building Commissioner OR it 200 Main Street,Hyannis,MA 02601 f4AY 0 9 2016 www.town.barnstable.ma.us Office: 508-862-4038 �� _. aUNFyaax. �,Q;8 ij96 j BLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number �3� / � Not Valid without Red X-Press Imprint r Property Address�,_) �.L- I C_ C. d�W 1 ULF �D4 )(Residential Value of Work$ 1�. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address M&&C.A \Y yT L_ T�eAr c> .Ir ®2/--,3 2 Contractor's Name Ak L fxjag }-{D"F-1-5 ,M C• Telephone Numberc.�9� U 62 Home Improvement Contractor License#(if applicable)_ l Q"'p,--lj(°)3 Email: Construction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I 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 �, •�V `r M '� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is re ui ed. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 l.. t Ah I\ on on CARE FREE HOMES, INC. EST. 1978 BUILDERS & REMODELERS 239 Huttleston-Avenue, Fairhaven, MA 02719 Telephone (508) 997-1111 Fax (508) 997-1297 carefreehomes company.com To the Town of: crz_t--�k Job Address: A -r/?-w A L owner of the home at the above address, authorize Care Free Homes, Inc. as my agent to obtain all necessary permits and to perform all home improvements to my home as stated in the accompanying contract and application. Customer Signature Date Care Free Homes, Inc. 239 Huttleston Avenue, Fairhaven, MA 02719 508.997.1111 - carefreehomescompany.com CERTIFICATE OF LIABILITY INS URAN THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE Dcr ATE 11201IYYYY) CERTIFICATE DOES.NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED g CE 91FR.01/2015 BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING FORD E BY HE POLIO THIS REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER Y THE POLICIES IMPORTANT:lithe certificate holder is an ADDlT10NAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,AUTHORIZED the terms and conditions of the policy,certain policies may require an endorsement A statement d.this certificate does not IVED, certificate holder in lieu of such endorsement(s). ED,subject to o PRODUCER r rights to the Herlihy Insurance Group Inc. NAME: Pat BOSS 51 Pullman Street PHONE A/C Ne Ext-508 756-5159 AX Worcester,MA 01606 IAA L aC,Ne: 508-751-5747 ADDRESS: certificates@herlihygroup.Com 508 756-5159 PRODU E CUSTOMER ID al: INSURED Care Free HomesINSURER(S)AFFORDING COVERAGE Inc INSURER Liberty Mutual Insurance.Co. NAlcit 239 Huttleston Avenue INSURER B:EastGuard Insurance Company -- Fairhaven,MA 02719 INSURER C.Safety Insurance Company } INSURER D INSURER E: _I COVERAGES CERTIFICATE NUMBER- , INSURER;:: _ THIS 15 TO CERTIFY THAT THE POLICIES UI INSURANE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLI Y PERIOD INDICATED.N0TIMTHSTANDINGANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITHI RESPECTTO R. CERTIFICATE MAY O ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. ' FXCLU IOIJS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN WHICH THIS .71, MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE DD UBR D POLICY NUMBER POLICY EFF POLICY EXP (� Li,ENERAL LIABILITY MM/DD MM/DD BKS56134197 09/01/2015 09/01/201 EACH OCCURRENCE LIMITS � XI COMMERCIAL GENE;R,SL LIABILITY $1 OOO OOO _'~� _— CLAIMS MADE OCCUR PREMISES Ea occurrence $300,000 1 MED EXP(Any one person) $15,000— ---� PERSONAL 8 ADV INJURY — GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 OOO,OOO POLICY PRO' PRODUCTS-COMP/OP AGG s2,000,000 LOC C I AU70MOBILELIABWTY $ 6213850 07/01/2015 07/01/201 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $1 000,000 ALL OWNED AUTOS BODILY INJURY(Per person) $ �— X SCHEDULED AUTOS BODILY INJURY(Per accident) $ X HIRED AIfrOS PROPERTY DAMAGE X NON-OWNED AUTOS (Per accident) $ $ I � UMBRELLA LIAg OCCUR $ EXCESS LIAR CLAIMS MADE EACH OCCURRENCE $ DEDUCTIBLE AGGREGATE f $ RETENTION B WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY CAWC603045 ANY PROPRIETOR/PARTNER/p(ECUTIVEY� N/A 09/01/2015 09/01/201 X wcsrgru- OTFI- $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.EACH ACCIDENT $1 OOO,OOO It yes,describe under j DESCRIPTION OF OPERATIONS below EL DISEASE-EA EMPLOYEE $1,000,000 E.L.DISEASE-POLICY LIMIT 1$1 000,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(Attach ACORD 1 11,Additional Remarks Schedule,if more space Is required) I CER?1FICATE HO!DER r CANCELLATION 10 Days for Non-Pa ment I I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE j Town of Abington THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 1,14 500 Richard Francis 611iniewic2 ACCORDANCE WITH THE POLICY PROVISIONS. Way I ENTATIVE Abington,MA 02351 AUTHORIZED REPRES A(70RD 25(2009109 9"'�4�0�988-200�9'I of 1 The ACORD name and logo are registered marks of ACORD D CORPORATION.All rights reserved. Jr`i845871M84576 JXC Department J o .r1UJJ71C/lttsetts f I11dustriaj 4ccidents Office ofinvestigations 600 Wasltirtgton Street Boston,AfA 02.11, Workers' Cori . wWw.mass A licazit Info pensation Znsurazice davit: Bu v/dia rmation alders/Contract Name(Business/fir Ors/Electricians/plumbers ganiz,7tiotUlndividual): ' Address: Please print Le ib] City/State/Zap: • Are yotr a,,e n'Ptoycr?Check tht appropriate box; Phone#: l• am a employer with employees —� 4 Q I am a f l 2.Q I am a (full and/orpart-tinge. general contractor and I Type of sole proprietor or a ) have hired the sub-contractors Project(required): ship and have partner- listed on the attached sheet. 6' Q New construction workin no emPlOYees These sub-co r for in any capaci ntractors have 7' remodeling �o workers' comp, insurance employees and have workers' re wired.] 5 mp• insurance. 9' �Demolition 3' I ."'I a homeowner doing all work We are a co Buildin • myself: � corporation and its Building addition NO workers' officers have exercised their 10'0 Electrical re insurance re comp' right of exe pairs or additions quired.]t mptionPerMGL I1•❑Plumbin . c. 152, §1(4),and we have no g repairs or additions employees. .12.❑ Roof repairs +A°y applicant tom Io workers't1tal checks box#I must also fill out the section below showing their 13.Q Other ' 1 Homco�mers wlto sub P•insurance required.] tContractors that c:uck this boXadavit indicatin CM "'a" must attaclted an additional sllcctg all shoivork an workers eomPcnsation .. If tltc sub-�ntraetors have c d then hire outside Policy information. mPloYccs,the n8 the name f contractors must submit a ncw I ant art employe, Y must provide their tlu sub contraeton and state whetlurorn�ahosc entities have p Dyer that is workers'comp,poll eating such. it formation,, providing workers'tom o7'number. pensatiort insurance for my empioyeey Below ' Insurance Company Name:me: . �s-� rs the policy and job sire Policy#or Self-ins,Lic.#; C �d3 DES Job Site Address: --�_ Expiration Date; Attach a copy of th ...................... e workers) Failure to secure covera e s compensation policy declaration Clt'/State/Zip; fine u g as required under Section 25A,of Page(showing the p to$1,500.00 and/or one- policy number and expiration date). of up to S250.00 a dayYear imprisonment,as well as ciirvtic• 152 can lead to the imposition of criminal e Investigations of agalnst the violator. Be advised that a co penalties in the form the DIA for incur PY of this statement of a STOP Wpm C Penalties of a once coverage Of may be forwarded RDER and a fine I do kereby c rti rwarded to the Office of under the pains an Si ature: it °fpe1jury!gran the atitin ' provided aboYe is true and correct. Phone# -7 Date: Off cial trse otriy.City or Town D°,rot write In t 'Iris area,la be completed by City or town official ' : _ Issuing AuthorityPermi 1.Board of .BuildingDc(circle one); tlLicense# 6.Other $calth 2 art P tnent caIIas"City/TownClerk 4.Electri e • . Contact Person: p ctor 5, Plumbing Inspector I Phone#: Massachusetts Department of Public Safety Board of Building Regulations and Sta License: CS-095228 ndards Construction Supervisor k DANA J PICKUP 239 HU :. :. �. S F TTLE TON AVE, AIRHAVEN MA 02719 Commissioner Expiration: 03/22/2018 earnmao�zcoeatl�b�� �a�dac%utelt _. �. CGce•?Q'ftaitsumer Affairs.-WZu4ness RtturatiLm i-e ft orrggisfr tian valid:for itfdi 4iiltil usrottly ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration:.,,.1,00503.: Office of Consumer Affairs and Business Regulation Ex iration TyPq7 10 Park Plaza-Suite 5170 P 6f19/201.6' Suppi-nent � d C7�RE FREE HOMES','fNG',, .."'Boston,MA 02116 DANA PICKUP JR. f39 Huttleston ave Fairhaven,MA 027.64 Undersecretary. Not, d;w ho .sig .;r Amnesty Program Helping to make affordable housing possible. F� Lown ® msc�tPle NOR Certificate of Compliance This certificate indicates acceptable minimum habitable requirements per Massachusetts State Building Code and Town of Barnstable zoning ordinances in accordance with the Amnesty program. Owner Marcia Wytrwal Location,:..: 61 Tellegen Trail, Centerville. x ' Unit Capacity Studi6)Avartmont,not to exceed One Person r; Inspector °,.,. M/P No. 230/149 5/22/2013 t ' . Town of Barnstable Building Department - 200 Main Street MRNRMBLE. * Hyannis, MA 02601 M.3 ,�' (508) 862-4038 OPFp�s Certif icate of Occupancy Application Number: 201207338 CO Number: 20130056 Parcel ID: 230149 CO Issue Date: 05122113 Location: 61 TELLEGEN TRAIL Zoning Classification: RESIDENCE D-1 DISTRICT Proposed Use: SINGLE FAMILY HOME Village: CENTERVILLE Gen Contractor: MICHAEL AUPPERLLEE RENOVATIONS Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: AMPESTY STUDIO APARTMENT Building Department Signature Date Signed �tHE TOWN OF BARNSTABLE B u Yld 201207338 ,,j n g BARNSTABLE, * Issue Date: 12/17/12 Permit MASS 0399- Applicant: MICHAEL AUPPERLLEE RENOVATIONS RFD�a Permit Number: B 20123044 Proposed Use: SINGLE FAMILY HOME Expiration Date: 06/16/13 Location 61 TELLEGEN TRAIL Zoning District RD-1 Permit Type: AMNESTY W/CONSTR RESIDENTIAL Map Parcel 230149 Permit Fee$ 40.80 Contractor MICHAEL AUPPERLLEE RENOVATIONS Village CENTERVILLE App Fee$ 50.00 License Num 153440 Est Construction Cost$ 8,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND USE EXIST RM OVER GARAGE FOR AMNESTY AFFORD APT 7BYTHIS CARD MUST BE KEPT POSTED UNTIL FINAL BLDG EXTERIOR EGRESS SET STAIRS&ADD SMOKE DETECT&H ATINVECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: WYTRWAL,MARCIA JOCELYN BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 61 TELLEGEN TRAIL INSPECTION HAS BEEN MADE. CENTERVILLE,MA 02632 Application Entered by: JL Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY'ANY STREET,ALLEY OR SIDEWALK.OR ANY PART THEREOF,EITHER TEVPORAkILY V E ENCROdCHMENTS ON PUBLIC PROPERTY,NO. SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION STREET OR ALLEY:GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC'SEWERS'MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORK&.'THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). �> ji I= BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS �x 2 2 2 �5 4 3 1 Heating Inspection Approvals Engineering Dept Fire Pep 2 Board of Health -75 r Nk f � YO i Z 1 I- [Yf s' T' r l r , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ��� Parcel Q Application Health Division Date Issued L Conservation Division Application Fee Planning Dept. Permit Fee t�• 7�� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis N Project Street Address 61 '1 e f(?,j e_.1 rim? Village Owner hay c i 4 �u r, r Lu / Address Telephone S ®S '7-/ Al39 Permit Request It 5e 4ex%s r`elo m © v e, g�^c�e�e �o r a m i1 pS J`y � � sdl�e e7le e/®a a Square feet: 1 st floor: existing.1960 proposed 2nd floor: existing /966 proposed ® Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ©®� Construction Type wood Lot Size 9 26 Ob Grandfathered: Ad Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: W Full ❑ Crawl ❑Walkout ❑ Other Basement.Finished Area (sq.ft.) 6 Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ,W Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes No Fireplaces: Existing / New Existing wood/coal stove: ❑Yes 49 No Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑` isting 0 newr hize_ Attached garage: td existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: kr� Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes �tNo If yes, site plan review # Current Use Proposed Use S� 0 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 4n0va ;0-g 5 Telephone Number SO BS 77� 9"?3d Address License# 0 ty 9 9 Home Improvement Contractor# '/ 't U Worker's Compensation # k/Cc Sore 6?70,/96 a ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 15a^n e,"le te4,nw A l/ SIGNATURE. DATE_� a n ` FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED o _ I MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION 0 s FRAME INSULATION s FIREPLACE `! ELECTRICAL: ROUGH FINAL F z w PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Y /3 I? a , DATE CLOSED OUT ASSOCIATION PLAN NO. T11e Commonwealth of Massachusetts Department oflndustrial Accidents a Office of Investigations ' 600 Washington Street lr Boston, MA 02111 www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plulrlbers Applicant Information Please Print Le0bly Name (Business/Organization/'Indi Adual): 14 :C6 4 Aid a 1.2e e»®Ua 7-I Ost S' Address: /J San4h gpod 1-91- City/State/Zip: 66 J-t trf AM o a6 3 5r Phone #: 5�63S. 72 6 9 310 Are you an employer?-Check the appropriate box: Type of project(required); 1.® I am a employer with—1 4• ❑ I am a general contractor and I - have hired the sub-contractors., 6. ❑New construction einployees'(fiill and/or part-tirne).+ -- ---— — -- 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 mein any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We area corporation and its 10.0 Electrical repairs or additions officers have exercised I L 3.El I am a homeowner,doing all work h id their ❑Phimbin&repairs or additions myself. [No workers'.comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c, 152, §1(4), and we have no employees. [No workers' 131Other 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, tContractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether or not(hose entities have employees, If the sub-contractors have employees,they must provide their workers'comp,policy number. fain an employer that is providing workers' compensation insurance for my employees. Below is the policy and jab site info rmado;r_ _ Insurance Company Name: 0�-155 0C t C e ol Policy# or Self-ins.Lia #: GAGC <611 6970 f 2-0 / Expiration Date; 150/I 3 Job Site Address: e�/ �L�e� 3 7_Aat1 Ce,,�zie-P0I'lP City/State/Zip: 1r4 ©a46 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 up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I.do hereby certify c der the gins a enalues of erjury that the information provided above is trite and correct Si ature Date; �o �� ' Phone#• S'6�5 � 7L g �3 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 Clerlt 4. Electrical Inspector S. Plumbing Inspector 6, Other Contact Person: Phone#: t .-- CERTIFICATE 'OF -LIABILITY INSURANCE - _ EATE(MM/DWYYYY).. ,. PRODUCER z 12 f, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MCSHEA INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1550 Falmouth Rd Ste #2 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Centerville, MA 02632 508 420-9011 INSURERS AFFORDING COVERAGE NAIC# INSURED Aupperlee, Michael DBA INSURER A: Associated Employers Insurance Michael Aupperlee Renovations_ INSURER 8: 169 Sandlewood 'Drive INSURER C: Cotult, MA 02635 INSURER D- 508-428-6654 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT;TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY EFFECTIVE POLICY EXPIRATION LTR Nseo - POLICY NUMBER DATE MMIDD/YY DATE MM/DD/YY - LIMITS. GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEL) PREMISES Ea occurence $ CLAIMSMADE F—IOCCUR MEDEXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE. $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JE� LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-O WNED AUTOS (Per accident) PROPERTY DAMAGE $ (Peraccident) . GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EA ACC $ AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CI CLAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND i WC ER OT TORH- YLIMITS EMPLOYERS'LIABILITY ANY PROPRI ETOR/PARTNER/EXECUTIVE WCC5011097 6/19/2012 6/19/2013 E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? —01-2012 E.L.DISEASE-EA EMPLOYE $ 5OO 000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500 ,000 OTHER DESCRIPTION OF OPERATIONSI LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpenter/ Included i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABO RIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,T ISSUING I URER WILL ENDEAVOR TO MA&4 DAYS WRITTEN NOTICE TO T CERTIFICAT ER EDT T fT,BUT FAILURE TO 0 SO SHALL Insured r S Copy IMPOSE OBLIGATION . LI BILI OF AN KIN PON THE INSU R, ITS GENTS OR. REPR TIVES. AUT IZED REPRESENTATIVE ACORD25(2001/08) ©ACO RPORATION 1988 Massachusetts -*Department of Public Safety 1 Board of Building Regulations and Standards I Construction Supervisor 1 & 2 Family License: CSFA-049205 :. MICHAEL J AUPP�]EtLE t, 169 SANDALWOOD DR Cotuit MA 026357 Expiration Commissioner 071141201.4 ✓/ze Pammxo�uuea�l/ /f/laaaac/zuaella �Office of Consumer Affairs&B siness Regulation i HOME IMPROVEMENT CONTRAGT012 ° : .Registration ;A53440 Type:. Expiration 12-112012 DBA MI AELAUPPERLER NbVA3TIONS MICHAEL AUPP9. LE � ; 169 SANDALWOOD��R COTUIT,MA 02636 �`r ' Undersecretary t. y i 't r i I 4 { Restricted -One-and two-family dwellings or any accessory building thereto, irrespective of size. , Failure to possess a current edition of the Massachusetts i State Building Code is cause for revocation of this license. For DPS.Licensing information visit: www.Mass.Gov/DPS I , i t, Lieense or Tegistration valid for individul use only i a before the expiration.date. If fouod return-to: l Office of'Consumer Affairs and Business Regulation 10 ParkPlaia-Suite 5110 Boston,MA 02136 Not valid without signat r t 1.. c' °FtHE tad; Town of Barnstable Regulatory Services •. snxxsraai.�, • y Mns g, Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner. 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038. Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Mare i Gam. J , W V—W Gd , as Owner of the sub ro e` l P P ttY hereby authorize 1�Y its��/ Dom,-2l1� � 4A"K s to act on my behalf, in all lna.tters relative to work authorized.by this building permit. el Ile (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. LJ Signatur of wne Signature of Applicant M 4l�G�OI J : 1 V Print Name „ Print Name • ao Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 r ��t Tay Town. of Barnstable Regulatory Services • =ARNSTABIX « Thomas F.Geiler,Director MASS. 1639. .�� Building Division rED MA'l A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstabie.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to xeside,on which there is, or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other. applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be.required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is-required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);prov7ded that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use.this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often:results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor: On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt I LEAD-SAFE HOUSING RULE—APPLICABILITY FORM Address/location of subject property: Regulation Eligibility Statements(check all that apply): Property is receiving Federal funds. v Unit was built prior to 1978. Note: If both Eligibility Statements above have been checked,continue with the Exemption Statements below. Otherwise,the regulation does not apply,sign and date the form. Regulation Exemption Statements [24 CFR 35.115] (check all that apply): Emergency repairs to the property are being performed to safeguard against imminent danger to human life,health or safety, or to protect the property from further structural damage due to natural disaster, fire or structural collapse. The exemption applies only to repairs necessary to respond to the emergency. The property will not be used for human residential habitation. This does not apply to common areas such as hallways and stairways of residential and mixed-use properties. Housing"exclusively"for the elderly or persons with disabilities,with the provision that children less than six years of age will not reside in the dwelling unit. An inspection performed according to HUD standards found the property contained no lead-based paint. According to documented methodologies, lead-based paint has been identified and removed; and the property has achieved clearance. The rehabilitation will not disturb any painted surface. The property has no bedrooms. The property is currently vacant and will remain vacant until demolition. If any of the above Exemption Statements have been checked, the Regulation does not apply. In all cases, sign and date the form. I, 44 e-1-- " P ,certify that the information listed above is true (Printed ) and accurate to the best of my knowledge. 4�ggngature Q J / Date Organization r r' Ek 26076 P914.7 4W`7852 �- 02-13-2012 a 01 =33P BIKE 1p� ti '12 .JANII -5 P 1 =03 �p i639. �0 fFOMA�� Town of Barnstable Zoning Board of Appeals Comprehensive Permit Decision and Notice Comprehensive Permit No. 2011-034—Wytrwal Chapter 40B Comprehensive Permit Summary: Granted with Conditions Date: November 9, 2011 Applicants: Marcia Jocelyn Wytrwal Property Address: 61 Tellegen Trail Centerville, MA Assessor's Map/Parcel: Map 230, Parcel 149 Zoning: RD-1 Zoning District Recording Information: Deed Reference: Book 13176 Page 051 Date Application Filed September 23, 2011 Date Hearing Opened November 9, 2011 Date of Decision (Closed): November 9, 2011 Property Ownership: The applicant is Marcia Jocelyn Wytrwal, who is the owner, occupant of 61 Tellegen Trail Centerville as evidenced by a deed-recorded in the Barnstable County Registry of Deeds on August 11, 2000 in Book 13176, Page 051. A copy of which has been submitted for the record. Relief Requested: Ms. Wytrwal has applied for a Comprehensive Permit pursuant to Chapter 40B of the General Laws of the Commonwealth of Massachusetts, and in accordance with § 9-14 of the Code of the Town of Barnstable, more commonly termed the "Accessory Affordable Apartment Program". The permit is sought to allow for an affordable apartment accessory to'a single family home as provided for in the Code of the Town of Barnstable and restricted to being affordable housing for qualified persons as. required-under Chapter 40B. The zoning relief necessary for this Comprehensive Permit to be issued is that of a variance.to Section 240-11 (A) Principal permitted uses in a RD-1 Zoning District.to permit an accessory apartment unit within the lower level of the dwelling. The issuance of this Comprehensive Permit would allow for a separate, approximately 600 square foot, studio accessory affordable apartment. Locus: The subject property is a 0.50-acre lot located at 61 Tellegen Trail Centerville, MA. The lot was developed in 1972, with a Cape Cod style home. The living area of the dwelling is approximately 2,422 square feet. - - ------ ----- -- - -- - ._�—::-.:_—_.:_::,::.::.::: _:•___ _. - __:._.__._.:.: B 26076 Pg 14 8 #7 8 5 2 Town of Barnstable,Zoning Board of Appeals Decision and Notice,Comprehensive Permit No.2011.034-Wytrwal Site Conditions The lots is served by Public Water, Gas and an on site septic system. The Town of Barnstable's Health department reviewed the application, and approved a total of four(4) bedrooms for the entire property. Procedural & Hearing Summary: A site approval letter was issued for the property by Town Manager John C. Klimm on September 22, 2011 in accordance with MGL Chapter 40B and 760 CMR 56.00. Notice of the site approval letter was sent to the Department of Housing and Community Development in accordance with the requirements of CMR 760 56.00. An application for a Comprehensive Permit was filed at the Town Clerk's Office on October 1, 2011. A public hearing before the Zoning Board of Appeals Hearing Officer was duly advertised in the Barnstable Patriot on October 14, 2011 and October 21, 2011, and notices were sent to all abutters in accordance with MGL Chapter 40B. . The Public Hearing was opened on November 9, 2011 at 6:00 p.m. by the Hearing Officer Laura F: Shufelt. The applicant, Marcia Jocelyn Wytrwal was present at the hearing. Cindy L. Dabkowski, Accessory Affordable Apartment Program Coordinator was also present. Laura F. Shufelt read the proposed conditions to the applicant. Ms. Wytrwal consented to the conditions. Ms. Wytrwal gave testimony as recorded in the hearing minutes filed with the Town Clerk The Hearing Officer opened the hearing to public comment. No one spoke. The November 9, 2011 hearing was closed by the hearing officer at 6:30 p.m... On November 9, 2011 the hearing officer granted comprehensive permit No. 2011-034 with conditions. A written copy of this decision shall be forwarded to the Zoning Board of Appeals as required by the Town of Barnstable Administrative Code Chapter 241, section 11. If after fourteen (14) days from that transmittal the Members of the Zoning Board of Appeals takes no action to reverse the decision, this decision shall become final and a copy shall be the filed in the office of the Town Clerk. Findings of Fact: At the hearing on November 9, 2011 the Hearing Officer made the following findings of fact: 1.. The applicant is Marcia Jocelyn Wytrwal who is the owner and occupant of the property located at 61 Tellegen Trail Centerville. Ms. Wytrwal is requesting a Comprehensive Permit to allow for a studio-accessory apartment within the upper level of the attached garage as an accessory affordable apartment.The allowance for the unit as an accessory affordable unit qualifies for the "Accessory Affordable Apartment Program (AAAP)." 2. Marcia Jocelyn Wytrwal was granted title to the property by deed recorded in the Barnstable County Registry of Deeds on August 11, 2000 in Book 13176 Page 051. 3. On September 22, 2011, a site approval letter was issued for the property by Town Manager John Klimm, in accordance with MGL Chapter 40B and 760 CMR 56.04 (4). Notice of the site approval letter was sent to the Department of Housing and Community Development, in accordance with the requirements of 760 CMR 56.04 (2), and no issues were communicated from the Department on this particular application. 4. The proposed accessory affordable unit is approximately 500 square feet in living area and is located within the upper level of the attached garage. 2 - -- - ----------------- :: =.:..::_.__:-_..�k 2607 g 1 #7852 - — 6 P 49 Town of Barnstable,Zoning Board of Appeals Decision and Notice,Comprehensive Permit No.2011.034-Wytrwal 5. The applicant was informed that the AAAP unit shall meet all applicable health and building codes to be occupied and that the Building Division and Fire Department will also be inspecting the unit for compliance with all applicable.building and fire codes. .. 6. The house is served by public water and private on-site septic. The proposal has been reviewed by Thomas McKean, Health Director, and he has approved a total of Four(4) bedrooms at the property. Health Director McKean'noted a special condition stating that the first floor"study"doorway shall be opened to minimum five feet wide as shown on submitted floor plans. 7. On August 15, 2011 the applicant Marcia Jocelyn Wytrwal signed an Accessory Affordable Apartment Program affidavit that commits, upon the receipt of a Comprehensive Permit, to the recording of a Regulatory Agreement and Declaration of Restrictive Covenants, in a form satisfactory to the Town Attorney, at the Barnstable County Registry of Deeds. These documents restrict the unit in perpetuity as an affordable rental unit. 8. The applicant is aware that the affordable unit shall be rented to a person or family whose income is 80% or less of the Area Median Income (AMi) of the Barnstable Metropolitan Statistical Area (MSA) and agrees that rent(including utilities) shall not exceed 30% of the monthly household income of a household earning 80% of the median income, adjusted by household size. in the`event that utilities are separately metered,the utility allowance established by the Town of Barnstable shall be deducted from rent level so calculated. 9. According to the Massachusetts Department of Housing and Community Development, as of August 31, 2011, 6.65% of the town's year round housing stock qualifies as affordable housing units. The town has not reached the statutory minimum of affordable housing under MGL Chapter 40B Section 20-23 or its implementing regulations. 10. The Town of Barnstable's Comprehensive Plan encourages the adaptive use of existing housing stock.to create affordable units and the dispersal of these units throughout Barnstable. Summary: The Hearing Officer ruled that the applicant Marcia Jocelyn Wytrwal has standing to apply for a Comprehensive Permit under MGL Chapter 40B and the Town of Barnstable's Accessory Apartment Program. The proposal was deemed consistent with local needs because it adequately promotes the objective of providing affordable housing for the Town of Barnstable without jeopardizing the health and safety of the occupants provided all conditions of the Comprehensive Permit are strictly followed. Conditions: Hearing Officer Laura Shufelt ruled to grant Comprehensive Permit No. 2011-034 with conditions in accordance with MGL Chapter 40B and Article II of Chapter Nine of the Code of the town of Barnstable, more commonly termed the "Accessory Affordable Apartment Program" to the applicant, Marcia Jocelyn Wytrwal who is the owner of the property located at 61 Tellegen Trail Centerville. As seen on map 230 as parcel 149. This Comprehensive Permit allows for a studio apartment unit in accordance with the following conditions: 1. Occupancy of the affordable unit shall not exceed one (1) person.. 2. The total number of bedrooms on the property shall not exceed Four (4). 3. The accessory unit shall NOT at any time be occupied by a family member.of the owner. 4. All leases shall have a minimum term of one year and have provisions that require the tenant to provide any and all information necessary to verify eligibility with the AAAP 3 -_--..:- __-__ ___.:•_ _:-, .-- -- -_-__ .. _ .._._-= :- .. . .:____Bk 26076 Pg 150 #7852 Town of Barnstable,Zoning Board of Appeals Decision and Notice,Comprehensive permit No.2011-034—Wyt val 5. On July 14, 2011, the applicant was sent written copy of the inspection findings, submitted for record, that the unit must meet all applicable health and building codes.to be occupied and that the Buiiding Division and Fire Department will also be inspecting the unit for compliance with all applicable building and fire codes. 6. The house is served by public water and on site septic. The application was reviewed by Thomas McKean, Health Director. He has approved the site for no more than four(4) bedrooms for the entire property. Ms Wytrwal will widen the doorway to the first floor"study" to a minimum of five feet wide as shown on submitted floor plans. 7. All parking for the accessory apartment and the principal dwelling shall at all times be on-site.On street parking for all structures and uses on this property is expressly prohibited 8. Lodging or renting of rooms is prohibited for the duration of this Comprehensive Permit. 9. To meet affordability requirements, the rent charged (including utilities) shall not exceed 30% of 80%,of the median income for household for the Barnstable MSA (adjusted for family size). In the event that utilities are separately metered, the utility allowance established by the town of Barnstable shall be deducted from rent level so calculated. 10. AAAP Coordinator shall be the monitoring agent for the accessory apartment. Annual monitoring shall include verification of tenancy, affordability, and compliance with Housing Quality Standards (HQS). The cost for HQS monitoring shall be covered by the homeowner. The fee for the initial monitoring of affordability and annual certification inspection of the accessory unit shall be the same as the Health Department fee for the rental registration program. 11.The applicant shall apply for a building permit for the accessory unit, whether the unit is new or pre-existing. Before issuing an occupancy permit and certificate of compliance, the Building Commissioner shall determine that the unit conforms to the approved plans as submitted with the building permit application and meets state building and fire codes. The Health Division shall determine that the dwelling is in compliance with applicable on-site wastewater discharge requirements. 12. The applicant may select her own tenant from the prospective tenants supplied by the Administrator of the Ready to Rent List. The tenant must meet the requirements of the Accessory Affordable Apartment Program. The tenant's income shall be reviewed and approved by the Growth Management Department. The applicant shall work with the AAAP Coordinator to provide necessary information and documentation of tenant income eligibility. 13.The unit shall be rented on an open and fair basis to an income eligible individual. Whenever a vacancy occurs, notice shall be given to the Growth Management Department and the applicant shall request potential tenants from the administrator of the Ready to Rent List. The applicant shall pay all fees associated with accessing the Ready to Rent List. In the event that the Ready to Rent List is not in effect as of the date that the Building Department issues its occupancy permit, the applicant may select the tenant after open and fair marketing, providing that documentation of the same is given to the AAAP Coordinator and the AAAP Coordinator Approves the tenant selection process. 14. Should the accessory affordable apartment become vacant the property owner shall immediately notify the Accessory Affordable Apartment Program Coordinator. The property owner shall also notify the AAAP Coordinator of their request for potential tenants from the Ready to Rent List administrator. 4 L I f Bk 26076 Pg 151 #7852 Town of Barnstable,Zoning Board of Appeals Decision and Notice,Comprehensive Permit No.2011.034-wytrnal 15. Every twelve months the applicant shall review the income eligibility of the AAAP unit tenant. No later than a year from the date of issuance of this Comprehensive Permit,the applicant shall file with the AAAP Coordinator, as Monitoring Agent, an annual affidavit stating the rent charged and income of the unit tenant. The property owner and/or tenant shall provide the AAAP Coordinator any additional information deemed necessary to verify the information provided in the affidavit. 16. Upon any report from the Monitoring Agent that the terms and conditions of this permit are not being upheld, the Zoning Board of Appeals or its Hearing Officer may hold a hearing to show cause as to why this permit should not be revoked. 17.This Comprehensive Permit shall NOT be transferable to any other person or entity without the prior approval of the Hearing Officer or Zoning Board.of Appeals. This decision, the Regulatory Agreement and Declaration of Restrictive Covenants and all other necessary documents shall be recorded at the Barnstable County Registry of Deeds 18. Should ownership of the subject property transfer the permit holder identified herein shall notify the AAAP Coordinator and provide, within 60 days of the date of transfer, the name and current contact information for the new owner of the subject property. 19.This Comprehensive Permit shall be exercised, all conditions met, and the unit occupied within twelve (12) months of its issuance or it shall expire. Ordered: Comprehensive Permit number2011-034 has been granted with conditions. A written copy of this decision was forwarded to the Zoning Board of Appeals as required by the Code Chapter 241, section 11 of the Town of Barnstable Administrative code. If after fourteen (14) days from that transmittal the members of the Zoning Board of Appeals takes no action to reverse the decision, this decision shall become final and a copy shall be filed in the office of the Town Clerk Appeals of the final decision, if any, shall be made to the Barnstable Superior Court pursuant to MGL Chapter 40A, Section 17, within twenty (20) days after the date of the filing of this decision in the office of the Town Clerk. The applicant has the right to appeal this decision as outlined in MGL Chapter 40B, Section 22. Laura F. Shufelt, Hearing Officer Date Signed Linda Hutchenrider, Clerk of the Town of Barnstable, Barnstable County, Massachoie6tt`-*oby., 6s,-,�'i, certify that twenty(20) days have elapsed since the Zoning Board of Appeals filed-N"46s, and that no appeal of the decision has been filed in the office of the Town Clerk. : Signed and sealed thisday o , °� nder the ins'anera1 ' O L a utchenri er,Town'Clerk BAMSTABLE REGISTRY OF DEEDS 5 Bk 26076 Fs152 �7853 REGULATORY AGREEMENY— � 2 iu i = 33p AND DECLARATION OF RESTRICTIVE COVENANTS THIS REGULATORY AGREEMENT and DECLARATION OF RESTRICTIVE COVENANTS,is made this 7th day of February 2012,by and between Marcia Jocelyn Wytrwal of 61 Tellegen Trail Centerville,MA and its successors and assigns (hereinafter the "Owner"),and the TOWN OF BARNSTABLE (the "Municipality'),a political subdivision of the Commonwealth; WHEREAS the Owner has been granted a Comprehensive Permit under Massachusetts General Law Chapter 40B and local regulations by the Zoning Board of Appeals to permit the creation of an accessory apartment in an owner occupied dwelling which will be rented to a Low or Moderate Income Person/Family(hereinafter "Designated Affordable Unit");and NOW THEREFORE,in mutual consideration of the agreements and covenants contained herein,and other good and valuable consideration,the receipt and sufficiency of which is hereby acknowledged,the parties agree as follows: I. PROJECT SCOPE AND DESIGN: A. The terms of this Agreement and Covenant regulate the property located at 61 Tellegen Trail Centerville, MA as further described in Barnstable County Registry of Deeds Book 13176&Page 051. B. The Project located at.61 Tellegen Trail Centerville,MA will consist of one accessory apartment unit which will be rented to an eligible low or moderate income individual or family(the"Designated Affordable , •, Unit" or the"Unit,'.'). C: The Owner agrees to construct the Project in accordance with the terms of comprehensive permit Appeal No.2011-034 and any plans submitted therewith and all applicable state, federal and municipal laws and regulations. Said permit is recorded herewith as Barnstable County Registry of Deeds'Book Zb p76 &Page lLl-1 . . D. The Owner agrees to occupy the principal dwelling unit located on the property as their principal residence in accordance with the.terms of the comprehensive permit. II. THE OWNER'S COVENANTS AND RESPONSIBILITIES; A. THE OWNER HEREBY REPRESENTS,COVENANTS AND WARRANTS AS:FOLLOW: 1 In receiving the comprehensive permit to create the Designated Affordable unit,the Owner agreed that the Designated Affordable Unit shall be set aside in perpetuityfor the public purpose of providing safe and decent housing to persons earning at or below 80%of the area median income of Barnstable Metropolitan Statistical Area(VISA) and that the Designated Affordable Unit shall be deemed to be impressed with a public; trust: 2. The Designated Affordable Unit shall be rented in perpetuity to a household with a maximum income of 80%of the Area Median Income (AMI) of Barnstable MSA and that rent(including utilities)shall not exceed an amount that is affordable to a household whose income is 80%of the median income of Barnstable NSA. In the. . event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent level. 3. The Designated Affordable Unit will be retained as a permanent,year round rental dwelling unit with at least a one-year lease. 4. The Owner has the full legal right,power and authority to execute and deliver this Agreement. 5. The execution and performance of this Agreement by the Owner will not violate or,as applicable,has not violated anyprovision of law,rule or regulation,or any order of any court or other agency or governmental body,and will not violate or,as applicable,has not violated any provision of any indenture,agreement,mortgage, mortgage note,or other instrument to which the Owner is a party or by which it or the Owner is bound,will not Bk 26076 Pg 153 #7853 result.in the creation or imposition of anyprohibited encumbrance of any nature. 6. The Owner,at the time of execution and delivery of this Agreement,has good,clear marketable title to the premises. 7. There is no action,suit or proceeding at law or in equity or by or before any governmental instrumentality or other agency now pending,or,to the knowledge of the Owner,threatened against or affecting it,or any of its properties or rights,which,if adversely determined,would materially impair its right to carry on business substantially as now conducted(and as now contemplated by this Agreement) or would materially adversely affect its financial condition. B. COMPLIANCE The Owner hereby agrees that any and all requirements of the laws of the Commonwealth of Massachusetts to be satisfied in order for the provisions of this Agreement to constitute restrictions and . covenants running with the land shall be deemed to be satisfied in full and that any requirements of privileges of estate are also deemed to be satisfied in full. C. LIMITATION ON PROFITS 1. The Owner agrees to limit his/her profit by renting the Designated Affordable Unit in perpetuity to a household with a maximum income of 80%or less of the Area Median Income(AMI) of Barnstable Metropolitan Statistical Area(MSA) and that rent(including utilities)shall not exceed an amount that is affordable to a household whose income is 80%of the median income of Barnstable MSA In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be . deducted from the rent. 2. The Owner shall annually deliver to the Municipality and to the Monitoring Agent,as designated by the Town Manager,proof that the Designated Affordable Unit is rented,the tenant's income verification,a copy of the lease agreement and the rent charged for the unit or units. Such information shall also be forwarded to the Monitoring Agent within 30 days of the occupation of the dwelling unit or units by a new tenant. The Owner shall notify the Monitoring Agent,as designated by the Town Manager,within thirty(30) days of the date that a tenant has vacated the Designated Affordable Unit. III. MUNIQPALITY QOVENANTS AND RESPONSIBILITIES 1. The MUNICIPALITY,through the monitoring agent designated by the Town Manager agrees to perform the duties of verifying that the Designated Affordable Unit is being rented in perpetuity to a household with a maximum income of 80%or less of the Area Median Income (AMI)of Barnstable MSA and that rent (including utilities) shall not exceed an amount that is affordable to a household whose income is 80%of the median income of Barnstable MSA.In the event that utilities are separately metered,a utility allowance established by the Barnstable Housing Authority shall be deducted from the rent. IV. RECORDING OF AGREEMENT: Upon execution,the OWNER shall immediately cause this Agreement and any amendments hereto to. be recorded with the Registryof Deeds for Barnstable County or,if the Project consists in whole or in part of registered land,file this Agreement and anyamendments hereto with the RegistryDistrict of the Barnstable Land Court(collectively hereinafter the"Registry of Deeds"),and the Owner shall pay all fees and charges incurred in connection therewith. Upon recording or filling,as applicable,the Owner shall immediately transmit to the Municipality evidence of such recording or filing including the date and instr unent,book and,page or registration number of the Agreement. V. GOVERNING OF AGREEMENT: 2 Bk 26076 Pg 154 #7853 This Agreement shall be governed by the laws of the Commonwealth of Massachusetts. Any amendments to this Agreement must be in writing and executed by all of the parties hereto. The invalidity of any clause,part or provision of this Agreement shall not affect the validity of the remaining portions hereof. VI. NOTICE: All notices to be given pursuant to this Agreement shall be in writing and shall be deemed given when delivered by hand or when mailed by certified or registered mail,postage prepaid,return receipt requested,to the parties hereto at the addresses set forth below,or to such other place as a party may from time to time designate by written notice. VIL HOLD HARMLESS: The Owner hereby agrees to indemnifyand hold harmless the Municipality and/or its delegate from any and all actions or inactions by the Owner,its agents,servants or employees which result in claims made against -_ Municipality and/or its delegate,including but not limited to awards,judgments,out-of-pocket expenses and attorneys fees necessitated bysuch actions. )IIII. ENTIRE UNDERSTANDING: A. This Agreement shall constitute the entire understanding between the parties and any amendments or changes hereto must be in writing,executed by the parties,and appended to this document. B. This Agreement and all of the covenants, agreements and restrictions contained herein shall be deemed to be for the public purpose of providing safe affordable housing and shall be deemed to be, and by these presents are,granted by the Owner to run in perpetuity in favor of and be held by the Municipality as any other permanent restriction held by a governmental body as that term is used in MGL Ch. 184,Section 26 which shall run with the land described in deed recorded herewith as Barnstable County Registry of Deeds Book 13176 &Page 051 and shall be binding upon the Owner and all successors in title . This Agreement is made for the benefit of the Municipalityand the Municipality shall be deemed to be the holder of the restriction created by this Agreement. The Municipality has determined that the acquiring of such a restriction is in the public interest. The Municipality shall not be subject to the defense of lack of privity of estate. The covenants and restrictions contained in this Agreement shall be deemed to affect the title to the property described in deed recorded herewith as Barnstable County Registry of Deeds Book 13176&Page 051. IY, TERM OF AGREEMENT: The term of this Agreement shall be perpetual,provided,however,that the Owner of a Designated Affordable Unit or Units may voluntarily cancel the granted Comprehensive Permit and the term and restrictions imposed herein. Such cancellation shall only take effect after: 1)expiration of the,lease terms entered into between the Owner and Tenant occupying said unit and 2)notification by the Owner of said dwelling to the Zoning Board of Appeals of his/her desire to cancel the Comprehensive permit upon a date certain and the recording of said notice at the Barnstable County Registry of Deeds or Barnstable County Registry of the Land Court.as the case may be,thus rendering said Comprehensive Permit void. Upon the cancellation of the comprehensive permit,the propertywhich is the subject matter of this restrictive covenant shall revert to the use permitted under zoning and the restrictive covenant shall be rendered void. X. SUCCESSORS AND ASSIGNS: A. The Parties to this Agreement intend,de"clare,and covenant on behalf of themselves and any successors 3 Bk 26076 Pg 155 #7853 and assigns their rights and duties as defined in this Regulatory Agreement and the attached comprehensive permit. B. The Owner intends,declares,and covenants on behalf of itself and its successors and assigns @ that this Agreement and the covenants,agreements and restrictions contained herein shall be and are covenants running with the land,encumbering the Project for the term of this Agreement,and are binding upon the Owner's successors in title,(ii) are not merely personal covenants of the Owner,and A shall bind the Owner,its successors and assigns and inure to the benefit of the Municipality and its successors and assigns for the term of the Agreement. M. DEFAULT: If any default,violation or breach by the Owner of this Agreement is not cured to the satisfaction of the Monitoring Agent within thirty(30) days after notice to the Owner thereof,then the Monitoring Agent may send notification to the Municipality that the Owner is in violation of the terms and conditions hereof. The Municipality may exercise any remedy available to it. The Owner will pay all costs and expenses,including legal fees,incurred by the Monitoring Agent in enforcing this Agreement and the Owner hereby agrees that the Municipality and the Monitoring Agent will have alien on the Project to secure payment of such costs and expenses. The Monitoring Agent may perfect such alien on the Project by recording a certificate setting forth the amount of the costs and expense due and owing in the Registry of Deeds or the Registry of the District Land Court for Barnstable County. A purchaser of the Project or any portion thereof will be liable for the payment of any unpaid costs and expenses that were the subject of a perfected lien prior to the purchaser's acquisition of the Project or portion thereof. XII. MQRTGAGEE CONSENT.- The Owner represents and warrants that it has obtained the consent of all existing mortgagees of the Project to the execution and recording of this Agreement and to the terms and conditions hereof and that all such mortgagees have executed consent to this Agreement. ,Y IN WITNESS WHEREOF,we hereunto set our hands and seals th0_i day of 2012. OWNER BY: Signature Printed: r-e-1 L_ COMMONWEALTH OF MASSACHUSETTS County of Barnstable,ss: On this 7th day of February 2012 before me,the undersigned notary public,personally appeared Marcia Jocelyn Wytrwal,the Owner(s),proved to me through satisfactory evidence of identification,which were to be the person(s)whose name(s)is signed on the preceding or attached document and acknowledged to be that he/she signed it voluntarily for the stated purposes. , No Public Printed: L• b_..a b K G}Lk)S 4 My Commission Expires: �� �192, i� CINDY 1. DABKOWSKI v� Notary Public COMMONWEALTHOFMASSACHUSETTS �� •r �`A1R� My Commission Explrea Februory 29, 2016 .0 '.'Y O" " �' .0rA 0 R 9V*4. �40TiYiti'������ r �,M�3SAG��B� Bk 26076 Pg 156 #7853 TOWN OF BARNSTABLE BY: TOWN hyNAGER COMMONWEALTH OF MASSACHUSETTS County of Barnstable,ss: On this 1r day of_/�lbraaV 2012 before me,the undersigned notary public,personally appeared 4, /u k, L ,the Town Manager for the Town of Barnstable,proved tome through satisfactory evidence of identification,which were a DSO kn fl /�, ,to be the person whose name is signed on the preceding or attached document an acknowledged to be that he/she signed it voluntarily for the stated purposes. NotaryPublic Printed: °y c e t"e rs u;f{ My Commission Expires: 191G "Notary Public" Joyce A.Persuitte Commomealth of usetts �,�. I�fNCOinmiw snr•,;�:•,p,;,�rc�s; :+:?.Yr": °� '.�7365?uu�l:4.t;��:C.a:.i=+i+::'a�:'c•::..�1^_9exc5[i+c�<.a . BARNSTABLE REGISTRY OF DEEDS 01/09/1995 00:33 91508790623E pie PAGE 0 o �rQ. ]olzzloy Town of Barnstable "Permit0 Firlm 6 mor+d d froer blue dare Regulatory Services Fee - T Tomas F.Gener,Director ++u+" gunding Division X�P E E To arr>Parry, �nildina Commissioner 20)Main Street, Hyannis,MA 02601 OCT 18 2004 Office: 508-862-4038. Fax: 508-790-6230 p� gq RNSTAE�.E ` EXPRESS PEI II�PLIGATIO_ N___MIDEW-BW .Vot Valid tv hout AM X Prets Imtprinr 1VIap/parcel Haber �,3 b N Property Lasq- esidcutial aloe of Work Minimum fee of$25.00 for wo er S6000.00 Owner's Nato&AddressOgLr-OL!2 Contractor's Name, !1 (!t � Telephone Number Home Improvement Contractor License#(if apI licable) /O Constmeti(m Svpervisor's License#(if applicab ie) O �/ J 0*6a's Compensation Insumce Check one: ❑ I am a sole proprietor a: n I am the Homeowner ❑ I have worker's C 'on Ins urance Instnance Company Name O So W orkman's Comp,Policy# -Y G �' / Owl) Copy of Insurance Compliance Certificate m wit be on Mi. Permit Request(check box) [] Re-roof(®tripping old shingles) A 11 construction debris will be taken to _ ❑Re-roof(not st:ippn& Going ova existing layeas of roof) Re-side (�cemcnt Windows. U-Value. (mmdmum.44) }What required: L yzptilpps. t Hance with other town department regulations,i.e.Historic,Conservation.etc. Z!2 pezty Owner trni d sign Property owner Letter or Pernnlss on. me v Con rs License is required. Signature Q:Forms:expmtrg Revise063004 _ Board of Building Regina " ons and Standards One Ashburton Place Room 1301 Boston.-Massachusetts 0210x Home lmproVernent Contractor;Registration " Reolstration: 104098 Type: Private Corporation Expiration: 7/13/2006 NEW ENGLAND'SASH; INC Kevin Wells 1331 Grafton Street Worcester; MA 01604 Update Address and return card.Mark reason for Chang ❑ Address [j Renewal Employment :Lost Card JPS,CA1 0 5OM-04104-G1011�216 .: ✓�E' Ct'Ullt tllQ9llt/2(YG4/L ll� G�JdCLfat[6JQCf4 -� �. r Board of Building Regulafious and Standards License or registration valid for individul use only 140ME IMPROVEMENT CONTRACTOR before the expirafinn[late If found return to: Registration; 104098 Board of Building Regulations and Standards Expiration 7/13/2006 OneAshburton Place Rm 1301, Type ''P1* to Co r poration Boston,Nla.02108 NEW ENGLAND SASH INC _ Kevin Wells 1331 Grafton Street Worcester;MA 01604 Administrator Not valid without signature i 05:0�/2@E��1• 39 7812732 .: '' ' .�� , ;-.. . .•� • - ', . - .: " . � •. . •. .. . . ; .. - - .'. • .• .. � 266.. 90 WCORSO ac ru 'CERTIFICATE OF C:1A USQzT3 BIL1 • IN-SUR 91 vRvvt;csn -SZ00 C T d 1)2 7l-O a 00 CAT[(NeVOc�YT y� tio�i:corao In>rur■nc• 4g■ncy THISCERTIFIGAT fSl O1/03/z001 43 Cambridge Street. OKAY AND CONFER3.NO RIGHTS AUPA��OFINFQ HOLDER.THIS CERTIFIC.ITE DOES NOT THE CER RMATItJN P.O. EXrF say zsoz AOLDER. H13CE OTAMEND, nPIC4TE Burl ingten• MA o [a3 RAc'EAFFORDED BY THE -INSURERS vs D No* England S[ah Ine. Ir fi■eional AFFO.RDINC COVERAGE 1331 Cralton street En■ryy syjt[ms IN NAIC# Hort c3tzr, MA 9J'604• e IN P4na-An■ricma ■I.nluranca Co naER6 Am4rie Ar puny INSURR C. Cbmp■n ' IN9l1AEA 4 'OYER/,GEs 1113UREltC T1:tE Pt7l1ClE9 OF+INSURANCE LISTED BELa:�/►A E BEENISSWED TO THE IhSUREO. ANY RERUIfiEt+1ENT,TEr�A1 OR CONOITIOy OP/1rVYC9NTRACI OR O _ 1,I>,Y pERT.41N TNE'.IN3URANCE AFFQRDEO aY TH THHR OOC NAXIEO ABOVE FOR THE P7L1^Y PE,q C0 hD' •PC WCIES.'rIGOREGATE LIMITS SHOWN 11AY H THE POL1G'i V. r. UMENT WITH REBpE�TQ Y;I tCFi 7F-;s C=R-Ft E MAC v0"V1(TIISTANOIN• E9 OE9CRIB ED HEREIN IS.SUBJECT T..ALL THE TERI..4S,E.?(;,L+,_1gIgN5 As OEEtiREvUCc'CJ 8Y PAID C eE I55!ED 0R'+l"Ns11 TYPi Ot!IN>:UAANC[ LAIMSI• O Co.#, Tl OF SUC-I I 01'HIAAL LIAINLTTy POUCYNU1t[[ 0 D IL , _ . I X. CLINIUHActtLCENERALLumuTY PAC62l1a75' 03110/2004- 03/1 �tw IMfNr07tYY 0/i D a 3 eAcrl occrA�-tic. Cu�M3 rdAaE �Ord _ i 2•,0 0 0'.0 0 C • .. IUfi-^:.Yr iC`y�N,7'77R1 I! .S 0,0 0 C - .. (DENL - :cv Ia,uf+Y 5,AGC�TGG:�TG Lri.4T A7PUE9 PFRr 0 0 0.� .. '' =3 veto. ^ GENEA+t.+:.cA.'•.�t= d Z.000,0.0.0 -.�jMU� tGGT LO. I.OUO,00'0 (.• 1 AUT0IUOBILG.l148ILITT PaO-tJCT�.CC-POP ACS I f • SnC In CA %ANY.AUTC. ., I . 'ALL:or+NEDAUTOS •CJLrCIN6]SIHGZE lJd1- t ([a d 9CNEOUm,AUroa :)4pzo aUTaJ S Fy. rlOn-OWNS ALITOa 1I001LY TLLATy ('ir modetr .CAFrAOtl,LIABILIT/ - '►1oP�ATt t1Ar l;C• . LVei'69ry MY AJTO . . A:.I a c-"-" "�ACCIOEVT I.• [XCMWMVhZLLA LtAjM TT7 CT4CA Tr.+N EA ACC 2 vj�C grS.r: occuR a CLAIMBMADE + A*G�s aacr CC:aaaic_. 3 ACCRt;,A,�,. . s 0.40UC1il[ . >R6T.ENTION i WORKy[TCOMT!ENSATION AND S r ':MPLOYeA9•L11[ILTT7 WC9 73 a 91 d a TN 0 s AttYrnCFRIET 04/z9/200/ 04123/2005 OFFC7INNEIAjEAKXC UDCjY�L�TIVC - '•Ct•T�k,:"s.� t;p,I dN=Ibq•under E L S.titi h^CC Q+,; _ SP Gr_IAl PROVISIONS eras 'so 0•,0 0 0 Orr�A E.L DISE l! EA 04FLOYe 13 5 0 0,o J 0 • 3.LOISGV3•�Cl1tr•rlll,;,; ! 500,0�7 , Ntri1 N T`.ON;tIOCA rIONS/.V4HICL!]!lXCltl,pH�APP D■Y H �,' - A3■FtR /3P■ tAa A %r-3"3 !! 'GATE NCILDER - C'�CFLL-A 11N ; =ApUID ANS OR TI4a AoQV[Cl1CR•J.(D PCY.r-IIIs■[CANCULIC■19oft rN■ QQQ [Xr1AaTION DAT[TttEltlOr THC 1JSLIACat;A :4tLLlNO[AVO■TOrAAIC _..0 Yys TTL40 T'ICLr rO;}{gCEA•i-t1G►T['-gLp[1I•H4U73To n4aLHPr, a ■l!r FAILURE f0 M.a1L 7VC31 HOIICS 7FL1L�:yr7�C NO 08UUAT10h•a:j 1.:ABIL1:Y li OF ArtT IOND U►ON 7Na INSUnEM.ITZ AO E.Ki OR entvr.%IrJT G . .. " '•tt<Tlw'rwsnrt:�eeea.� aErlt rTA�TVF, �-c r3 ° "Im, teMA01604rr4, 508 792 9181 800 goo 7274 t THISONTRACTmade the day of in the year between New England Sash, InC.and SO 77/- O� �- - - (HOME OWNERS) (HO (BUSINESS PHONE) M HONE) ` .+;(STREET) (TOWN) (STATE) (ZIP) r aj i i' As used in this contract the words we,us or our refer to New England Sash, Inc.and the words you.and o nd yr refer to the customer' We agree to furnish all labor and material necessary to install the following described windows at: _ t . nmo Double H.R `Ow Total Units: a Glass Glass Grids: Y N indow Color: 1 715 Material: J Double Hung Units: We do not do any painting or staining. 6� Installation: We are not responsible for conditions or circumstances Picture Units: / beyond our control including condensation resulting from Total Contract- 7 (� or due to pre-existing conditions.Our limited warranty is 7s Hopper Units: herein incorporated by reference. Sales Tax: 6 q Sliding Units: 2- 3-lite: Awning Units: 1-liter��2-lite: Casement Units: 1-lite: 2-liter ite: 4-lite: Total Bay/Bow Units: DH/CS 3-lite: 4-lite: -liter Price: 19 Garden Windows: Ite: 4-liter 5-Itte: Deposit C 75 Exterior Finish: Roof Soffitt Total Projection: Knee Brackets:Y/ N With Order: Svc Entry Doors: Steel Fiber Style: Add Deposit Storm Doors: Alum W. Core Style: p Due Date: Sliding Glass Doors: # Q ' Color: / Balance Due Capping N Y # I j'C- / On Delivery: Additional Notes: LL G� t 41) , AL.Ll �� �tSLdl dZ S14-C.GW42k/C to 1A)Da.) '�-/S is 09 emu- -t cprt rzAe2-E'- zTzw DEPOSIT WITH ORDER ❑ CASH 9 CHECK# BALANCE DUE ❑ CASH REFINANCE You agree to pay cash according to the terms shown above or,if your credit is approved,to sign a note provided by us for payment of the amount due.You also agree to sign a completion certificate upon completion of the work.If you fail to make payments when they are due,then we may immediately stop work.We may choose to not start work again until you are current with the payments and we feel secure in obtaining the remaining payments.If there is any stoppage of work due to the preceding,such delay shall automatically extend the date of substantial completion. Payments due and unpaid under this agreement shall bear interest from the date payment is due at the annual rate of 18%or at the maximum legal rate,whichever is less.In the event that we incur costs or expenses in collecting such payments due and unpaid,you shall pay such costs and expenses including reasonable attorney's fees.In addition,you understand that by failing to pay according to the abque Se tthes seller may have a claim against you which may be enforced against your property in accordance with the applicable liens laws. The installation will begin on or about &—W KS and will be substantially completed on or about '--? It is understood by you that the following contingencies could materially change the estimated completion date stated above: customer's inability to obtain or qualify for financing; inclement weather; strikes or other labor disruption; mon-availability of materials;acts of God. We represent that we carry Workers'Compensation and Public Liability insurance in the amount of$100 000-1 000 000 ALL RESIDENTIAL CONTRACTORS AND SUBCONTRACTS ARE REQUIRED TO BE REGISTERED WITH THE MASSACHUSETTS BOARD OF BUILDING REGULATIONS AND STANDARDS, UNLESS SPECIFICALLY EXEMPT FROM REGISTRATION. INQUIRIES CONCERNING REGISTRATION SHOULD BE DIRECTED TO: DIRECTOR, HOME IMPROVEMENT CONTRACTOR REGISTRATION ONE ASHBURTON PLACE ROOM 1301 BOSTON MA n?nda( 797 RF 8 `� CONTRACTOR OR SUBCONTRACTOR IS OBLIGED TO OBTAIN THE FOLLOWING PERMITS: A fW/L.L, 0I tj .IF WE DO NOT OBTAIN THESE PERMITS,AND YOU OBTAIN THEM,OR IF WE ARE NOT REGISTERED WITH THE BOARD OF BUILDING REGULATIONS,YOU WILL NOT BE ENTITLED TO OBTAIN ANY BENEFITS FROM THE GUARANTEE FUND ESTABLISHED UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 142A. ANY DEPOSIT REQUIRED UNDER THIS AGREEMENT TO BE PAID IN ADVANCE OF THE COMMENCEMENT OF WORK SHALL NOT EXCEED THE GREATER OF ONE-THIRD OF THE TOTAL CONTRACT PRICE.OR THE ACTUAL COST OF ANY MATERIAL OR EQUIPMENT WHICH HAS TO BE SPECIAL ORDERED OR CUSTOM MADE,WHICH MUST BE ORDERED IN ADVANCE OF THE COMMENCEMENT OF THE WORK,IN ORDER TO ASSURE THE PROJECT WILL PROCEED ON SCHEDULE.NO FINAL PAYMENT MAY. BE DEMANDED UNTIL THE AGREEMENT IS COMPLETED TO THE SATISFACTION.OF BOTH OF US. YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY THERETO AT A PLACE OTHER THAN AN ADDRESS OF THE SELLER, ,WHICH MAY BE HIS MAIN OFFICE OR BRANCH THEREOF, PROVIDED YOU NOTIFY THE SELLER IN WRITING AT HIS MAIN OFFICE OR BRANCH BY ORDINARY MAIL POSTED, BY TELEGRAM SENT OR BY DELIVERY, NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING THE SIGNING OF THIS AGREEMENT. BY SIGNING BELOW, YOU ACKNOWLEDGE THAT YOU OWN THE ABOVE PROPERTY AND THAT YOU AGREE TO ALL OF THE TERMS OF THIS CONTRACT. YOU ALSO ACKNOWLEDGE THAT YOU HAVE RECEIVED A FULLY COMPLETED COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION AND THAT YOU HAVE BEEN ORALLY INFORMED OF YOUR RIGHT TO CANCEL. DO NOT SIGN THIS CONTRACT IF THERE ARE#NY BLANK SPACES. IN WITNESS HEREOF parties have to signed their names this POI Aay of e year of Signed Sign MARKETING R ESENTATIVE OW10 Signed Accepted:New England Sash,Inc. By Signed AUTHORIZED SIGNATURE TITLE OWNER NOTICE OF CANCELLATION DATE(TODAY'S) YOU MAY.CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. Town of Barnstable iHET Regulatory Services ���3� �E �s }tSTA �� Thomas F. Geiler,Director • ]Building Division f #_ '_C E -2 _ ?[ * BARNSTABLE, * ` it .�' J va° MA SS. Tom Perry, Building Commissioner t639. - 'tEoa�Ata 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: ;D 100(cislo Fee: r$ S Permit#: HOME OCCUPATION REGISTRATION Date: a ao I C) Name: Loo S. U0C_,C_,-=>t0_ Phone Address: 1 Te. to!q�en ' l r3j Village: Ce nTe r ), I e— Name of Business:--__ G�S r L l_L1AZ1—\c6 cp— -- __ ---- ----- ----------------- ------ "hype of Business: �Unj�,(1Cj /nrl yab Map/Lot: 2 3 0 — 149 INTENT: It is the iuteut of this section to allow the residents of the'rolvn of Barnstable to operate a home occupation «2tlrirr single Family dwellings,subject to the provisions of Sectiou 4-I A of the Zoning ordinance, provided that the acti6ty shall not be discernible front outside the dowelling: there sliall be no increase in noise or odor; uo Visual alteration to tine premises WIRCh would suggest anything other than a residential use;no increase in traffic above normal residential volunies; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary lu>nie occupation shall be permitted as of right subject to the folloviug conditions: • The activity is carried on by the permanent re,iKleut of a single [amity residential chvelling unit, located within that dwel,liug unit.. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling rslriclr are not customary ill residential lnlilclirrgs, alld there is —p ✓ ' ^�� no outsicle evidence of•such use. C� N �v No traffic will be generated in excess of normal resicleutial volumes. • 1'He use does not.involve the production of offeusrve noise, ��bra I smoke, dust or other particular inatter, odors,electrical disturbance, lieat,glare, Humidity or other objectionable effects. o There is no storage or use of toxic or hazardous materials, or flammable or explosive materials, in excess of normal Irousehol�l quantities.Any need for parking generated by such use shall be met on the same lot containing the Customary Home yOccupation,and not within file required front yard. ,,,�© There is no exterior storage oi-display of materials or equipment. "There are no commercial vehicles related to the Customary Horne Occupation,other-than one van or one a pick-up truck not to exceed one toll capacity, and one trailer not to exceed 20 feet in length and not to . . exceed 4 fires,parked on the same lot containing the Customary Home Occupation. • No sign sliall he displayed indicating the Customary Home Occupation. • If the Custonr:uy Home Occupation is listed or advertised as a business, the street achlress shall not be included. • No person shall be employed in the Customary Home Occ•upatioll who is'riot a permanent resident of tlic d , ing ur [, the undersi nod, lave red p 1 agnee w he above restrictions for my home occupations I am registering. Applicant:' Date: I Z 2 It.(2) YOU WISH TO OPEN A BUSINESS? For.Your information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: 12. z la1 Fill in please: APPLICANT'S YOUR NAME/S: L4M S o L Co 4 BU INESS YOUR HOME ADDRESS: la( T CsoB 332--220S _Lke. M/A. ` TELEPHONE # Home Telephone Number _ p , e NAME OF CORPORATION: NAME OF NEW BUSINESS i-t Cu_kl t"&vCe TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO_ ADDRESS OF BUSINESS Osterro l )l 0 MAP/PARCEL NUMBER Z 3p - 14 (Assessing) }exu i I I e � -.�N C, 3�. When.starting a new business her arm s,&c ral things you must�o in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMQs R'Sa10E MUST COMPLY WITH HOME OCCUPATIC . This individu }in of ny ermit re uire ents that pertain.to this type of business. RULES AND REGULATIONS. FAILURE TO Author ed Si�nat e* COMPLY MAY RESULT IN FINES. COMMENT i r✓6 , r 2. BOARD OF HEALTH ✓6 This individual ha b infor e - f he Mit r u'rements that pertain to this type of business. Authorized nature* COMMENTS: 3. CONSUMER AFFAIRS (LI ENSING AUTHORITY) This individual has b r of h licen ing requirements that pertain to this type of business. Autl iurized Signature* COMMENTS: tii TOWN OF BARNSTABLE 1639- O 101 M BUILDING INSPECTOR Or ..... .............................................. APPLICATION FOR PERMIT TO ........ TYPEOF CONSTRUCTION ..............� ......................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according ,to the following information: ..T141f:�1 ................................... Location ................ ...... e4enmad.. ProposedUse ............. ................................................................................................................... Zoning District ........ . .................Fire District ........a)&zX&14�- - Name of Owner ...... ........Address ....... ...a. Name of Builder ........ ...Address ................ ........................................ Name of Architect ....... ....Address ...0�a-46y . Number of Rooms ...../.......... .......1��. ..............Foundation .......efo Exierior ....... ,.Roofing ......... ........... 1/? Floors ] . . :.................................Interior ................ .. . . . . Heating ................__e,.Ail-arAl ...................................Plumbing ..........16624:�&�.... Fireplace .......... 16 or 0- '10 ..iel ....... y C .......... ................c. ...3. .......................... .�'& App o m to Cost .... ... 0 NXI Difinitive Plan Approved—by Planning -oar Diagram of Lot and Building with. Dimen4e1_,0A__ M 0 Inb 1 ......... 0 ES 0 lit LLJ > < :0 M LL_ 0 lb- el S' LQ 00 LL, < Ljj UJI (D < C L < < t_zn T f CAi I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re—garding the above construction. .................. Name .t..G•IC .(s..a%.f�.:" 1�!r- laioxmzf^ Richard E. V \ No —. Permhfor -.—I I/2 �����._. -- - / a ' ` ^ ` --'.�������..��?��J[.���������.------- ` � . Location ---�k4pputn..±F4 ........................ ......................... ................................. / � ' | ' �� . Owner ---_.AiqbA��.�^..�Q�QP��............ � Typo of Construction ...........Iramet................... 6 } __^.__.~___~____.___,________.. ^ . ' Plot �� �� ---------' ----'=+----' Y ' � \ March 28 72 / � Permit Granted lg-------------' Date of Inspection --- . . 19 Du,o Completed wcv»� ��.=�� '��=�. . /° . .. . — � . � PERMIT REFUSED ^ ' . lA ----..--..---.....—^~..---- .----...—..,....—.--~----------- ^,._~,,___.,.,.~______,._______._ h -`-'---^^^^-'—^^~^^'~^^^^—~^'~'''~^'—^'' —'~^'�,^~---'^------''—^^--'----''' \ . aApproved ................................................ 19 ...................................................... .�' � .----------.--..---.--,.....,..- , 'T _e t !". t �, �"-••'-- + ----i-' I �. ,- _-- t ! -- ' • - --_-t- _T- k -�- -..;... .0� .�.___._.-tom. �..<. .. t i a_�ti !a _ _ �'(�tw�v: Y dt(J-1 i ' f ' 1 f`�_., � ,•._ 4 f r. 1 .( _i..__..._ r _..�. f k I 1 ` I -TOW 4-OF-B RN"TABLE- 4!�! 1 b- if{. _�.7 2012, $"i i 7' eA � • I ' i � t � -lam_. _ i _ .i__._..i..�... �- - -_ _ __. 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I ., t 1 �r+.,s....� Y i•w..... t € o P i � r i , .j, t -..•..-•t._.-, 1.....,v,:j.o.:.. _.�.� i -.- { ._.. .. .d,.....-. e ......,,�.. t i I € f /G FC. 4 . 1 a i t W f I h64as - 1E_: i ; a t f I _ � t i i t _ I t _.1..,....» .:..,._., ,..�._.. ._�..<<=EE7t'3,��-st` —�+1'•+._���G �`f�r.-.�_ _-V'- ___— — _.�—...,— �-�`_ — _ _ _ I F , r : t I ' � � � € 1 1 � f � j t i f , __ t .�.1...�..._ � _ _+ i..�......�,..-....:�...,�...,_.....,_.�,.,.�...�.w,.,�,.,„.�.,!..........�... .... _.�.�.. ,�. _ �_ ...----•F- � ., - . .._ '1,.€., ,� ,► .YP sT- �- ww_ v , t dt Como'� tL ,. € w...._.ter .....w_ , ! i � I 1. 1 � E { ( � � I � ' ���...�..}-•.�,..-i �......_ ....,_� a ... _..-....�.�._:..p. r.._,.'. ��4.._ � -.. i ._.„.,.._I E.....:m:,�_.....�,..._..,�.....,».:. .. _ ........_a�,,,,..�,..�,�. _.. -. .... _.,: _.....:.F �y.,..:��_ , ttt t ��7 EXISTING LEACH PI T EXISTING SEPTIC TANK Weduaquet TO BE PUMPED, FILLED TOP OF TANK=43.57 W,l SAND & ABANDONED, lNV(OUT)=42.24.t Lake I` TBM NO. 1 / Tog bolt/hydrant aP� 4 41,7 8 4.2 S 8`J OQ 00 E r EL.=48.00 (NGVD) --✓ x 44.51 Q�c 6N of x 43:33 X �) `t� I` `.1' fl Great Marsh Rd �o� "o^ Rpute i �/ ,- ` __\ _ , _ 2� y �6r ; PK/SET Rout cc�ti LOCUS (C / 5 :® 44,92 �/ 28 Qr f LJ D P I >; Vest St ., 44,03 45.14- ......._ I w" X 44,41 x r LOCUS PLAN N.T.S. `fit j 4 x 4564� I 4 71 8 a 44,56 _ •4 58 (' 45,35 f ;0 4 45r 3 Lot 5 X LE END I r: t T -.- i 45.39 1 g PROPOSED CONTOUR + i 22,262E F.S. _ •�. i + O.SIf AC. r: 45:55 ' 1 PROPOSED SPOT GRADE Mop 2JO f EXISTING CONTOUR I Parcel 149 --. 1� -`14.`1--� ,o` + I x. 11 EXISTING SPOT GRADE ^._ r `>4� 4 5.7 4 3 7 EX T G 46,U1 44VEN_T,, + i¢i ++ rid x 4 yq0 TEST PIT I - ! v - "�� '` W EXISTING WATER SERVICE r`� r;INSPECTION I a :14.0U _ t PORT EXISTING GAS SERVICE i s 4�,0 8 IXrSTlNG' r I E NE - HOUSE 61 , ( r� D.H. f�- - EXISTING OVERHEAD WIRES I 1 44:13 i :_- TOF=46.31 i I�r ;�TP-2 0� ; I ii SEF'T C GdNLC1V' �J,,X�� t + + --U.G. V+L- EXISTING UNDERGROUND WIRES j 1 ��qq�j TP-1 1� 46r131 x I s '" - 4 �`?7 ! " �0���� i ' 1P,T._-L1AK i a ,. . SLEEVE SLWER x" 31,67' sz I s� AT C{OSSJNG I w446,93 4 6 45 45• - lB NO. T Gas Shutoff o PETER T. 16 ) ,aC: � 4 7.14 ' LIE_Lc)P= MCENTEE. �.p0' G J . 47. 14 (NGVD) o CIVIL N GENERAL NOTES: TBM N0.3 N �6�a,. p x 45.15 ,i �k�: 46.16 1 Top Con c. Wall + o. 35109 - Iy 4 6,0�x f ,op �i'EGIS�F.`�``0 .�2 EL.=46.31 (NG VD) j` Fs 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL ��`. Y �"' 3 \ S BOARD OF HEALTH AND THE DESIGN ENGINEER. , 1 ' O.QQ' 1 t I FLOOD PLAIN DESIGNATION 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS it N 8300'Qp" W x i47, 6 Community-Panel No. 250001 0005 C LOCAL THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. ��- Map Revised: August 19, 198_`i Z� l�� LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: t'-310 CMR 15.405(1)(b): 8. THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. Zone "C" 1) A 2' variance to the 3' maximum cover requirement, for 5' of 9. ALL AREAS CLEARED FOP, CONSTRUCTION SHALL BE RESTORED AS max. cover. S.A.S. shall be vented. Q4's are rated for > 6' cover. AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE' PROPOSED SEPTIC SYSTEM UPGRADE PLAN 3. TH DE 10. IT SHALL BE THE RESPON E SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR DIRECTED BY THE APPROVING AUTHORITIES. INSPECTION AND APPROVAL BY THE BOARD OF HEALTH THE SIBILITY OF THE CONTRACTOR TO VERIFY THE DESIGN ENGINEER. . THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 61 TELLEGEN TRAIL, CENTERVILLE, MA 4, ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING CONSTRUCTION. FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE;!SUILS Prepared for: Marcia Wytrwal, P.O.-Box 2606, Hyannis, MA 02601 ENGINEER BEFORE CONSTRUCTION CONTINUES. IN THE AREA BENEATH AND ON ALL SIDES OF THE S.A.S. AND REPLACE Engineering by: Surveying by: SCALE DRAWN JOB. NO. 5. ALL ELEVATIONS BASED ON NGVD ELEVATIONS. WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). EnglneeringWark4 WARNER SURYETING 1"=20' P.T.M. 250-07 6, THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 12. EXISTING SEPTIC TANK SHALL BE INSPECTED FOR STUCTURAL INTEGI.ITY 12 West Crossfield Road 22 Long Road THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF ::Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. AT TIME OF INSTALLATION. IF FOUND IC BE DAMAGED E SSTALLE gLLY UNSOUND, A NEW 15U0 GALLON SEPTIC TANK SHALL BE IM1ISTALLED 12�18�07 P.T.M. o( ) f 2 TOV-01 O BAMISTABLE pPV lSc?1} r .1