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0522 COTUIT BAY DRIVE
G I . .�..�. , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 2—/h.A 1e� ��lJ Map v� Parcel. ��� �n.� Application I C/ Health Division nA Date Issue CT � Conservation Division TO�w U �2�16 Applicati e Planning Dept. F�' R�"�� Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village f Owner�e1"`�'r f''®�t�-/�� Address ,�`2 Z e-0701� 13-_�p b� Telephone tl:�7:S 9 2 -3 Permit Request /�.-C i' 10 -�ov) 6%2 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ®DA' Construction Type eN�yzz,//� ✓ i3� �a�''�f 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 0lo On Old King's Highway: ❑Yes 0&0 Basement Type: VLFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) �`j Basement Unfinished Area (sq.ft) Number of Baths: Full: existing V new Half: existing f new Number of Bedrooms: — existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: t Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes $lo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ��?® y ��'`�S! _ Telephone Number -V�" y7),33 9'y Address �Z /�fCd/�G/l�J f � License # 0 y612-3 1 Home Improvement Contractor# 3 Email V rf7 rG C✓ ✓F /-0 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE FOR OFFICIAL USE ONLY APPLICATION # ` DATE ISSUED MAP/ PARCEL NO. .� ADDRESS VILLAGE , OWNER DATE OF INSPECTION: FOUNDATION , FRAME INSULATION f' FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL GAS: ROUGH FINAL l FINAL BUILDING ri 4 DATE CLOSED OUT ASSOCIATION PLAN NO. `• The Commmmeakh qfMamwJHtset& MiN Deparbaent ofradmaid Accidents Bice afro. 600 Waslririg m Slred Britons,MA 02.LT1 . . fvrvnr.ma�gavf�a Warlm& Compensatun Insurance Affidavit Sma-klerslE�au ers AppHcard Iufarmiat ' Please Fria Name his Addges /// A `j2 phom Are u an emglayer?(peck appropriate bow Tyke of project(rid}= L X1 am a 1 vzifh 4. ❑I am a general c�cksr and I 6- ❑New eomsblu empk�(ar�for�* havehh-edffm 2.❑ I am a wle prvprieftw orgartaw- listed omilhe atWchad sheet 7- O-Re= Hug ship and have no emplayem These sub-(.�a have 9- E]Demdikbn talon g fnrss�e is arr�capac�fg_ ��andhave wods' [No Wridoers•gyp-n+ + corny_ $ 9. ❑ addifioa -j 5. ❑ We are a cmpomfian and its l4❑1 ca1 repairs cr ad&fions 3.❑ 1',ama bomemmu doing all work officen have eseresed their 1L[:]Flumbiagregaiss or adcfifioms myself[No wc6mm'omp- righL of es gfiaa per MCA, i?❑RDofrgMf= ;f,=e regdled-]1 c.M,§l(4k aadwebavemo employees.[NowoADrs' c=gxkmranceregd ue&] •� ��boz�,�t�fin���be� theua�ed'�Pers�oQporsginf�� #�ecaraea submit d3is z SCA =C==Lct=fWC t9hed[tWm boa=st atta hsve emPbYe s.7f th m*-taa>zad k=e mq&Tea-,tfieYmans,&thm wmi=eP•Fly=mnb- I am art entplgw f7ratis prm idfrrg workers'cvmpensaffan m=raase fur ury w_T. Below is firs pvEcy and job sits �formaiica - Ia�arautze •Pafic-y44orSe1f-inL11-r-*. fG-/1-17 Job Site Address: Cifg/Skafeg: Arch a copy of the worker'compeusationp.olicg deg Ja-afion page(showing the poRcy number and topiration date). Fai-lam to sew coverage as required under Sertma 25A.of MQ.m 1522 can lead to rite imposition of crimiiral pe mW of a fine up to$1,SOa OD and/or one-gearimprasonment,as well as civil peuslge in the farm of a STOP WDRK OMI Rand a time of up to$250M a day against the violainr. Be x&ised fiat a copy of this sWement maybe ceded to the Office of lavestkptions of le,DIA for Risurame.coveege vedffc$tiom. Ida hersby cerhyy ender&A mid 4�fpednq fJW the atformadm providni above is true and correct Pitatte ��� •� ��y�G �'7��7 jai wa anfy. Do iW write in dib area,&be.c mnpFeted by diy arfDiva 00'rs/at City-or Taw= PermftUcenn# Lwzing Aaffiardy(code one): L.Boa3d of 3.BmtTsfiag DeparEmrt 3.6fyfrovm Ckxk 4-Efech ical Fuspector S.gybing bnspecimr 6.OOHW Contact Person: rho= 6 baformation and lhastractionsr t mrh==ft Geaeaal Laws chsptw M requirm all a urpla =In I�e "P on fir their=P10 -= • — Mga pa�-aa�in.f3zis sue,��F°3'�is dried as¢.every prasoa m.ffie service of �dr�suy co�xact of7mr., express or imaplied,oral err written." An=,wIaym-is d as` n nffMftA per, °m,coQpon` =or affi=legal may,Cr my iWo or mare the:a_c;g'om =pgtd is&J� and the legal=7==tafives of a deceased enlpIoyet,or ffie of rerei4ra or tras6ee of an par�b aSSDI i —Cr pihaslegal edity,=Ploymg�PmY - liowcver the own=of a.dwelTmg hanse havmg not=me than tbree apartme��dwhn residrs toeae�,or�occ�aftbe - dwallmg hDI=of anofer who csupIays Prawns to CID maw won or reps¢worjc on stQ:h dweIImg pause or orl the gro=& or bMIdmg apppzteaantfaM�shaIlnotbecanse of sarh emplaymentbe deemedti)be an.employe" MGL cllapt=r 152,§25C(6)also states that¢every state or local licensing agency shall wif hold ffie imnance or renewal of a license or permit to operate z bm iaess or to construct bmldmgs is the co—anweatffi for any applicant Who has notproduced a=ptable evidence of comer=—with the insvarance coverage regaired- AddtionaIIY,MG=L ChaptCr L52,§25CM states-Neither tb c ceam-MWCalft nor jrny ofits poHtCal snbdr4isions shall carer ihfu any contract for the,pecOmmanx 0f2nbrmwo3c=1 acceptable wide of compliancewi9ltheinsm3ce. rCTIE-eaieTEs of this dUpt=have bees preseatPd in the g MffiDZdY Applicants Please fry o� thz-Fva]as'camPensaflon affidav completoly,by g the boxe s that apply to your sdnattan and,if necessary,Supply Sdl �s)nae(s), address(es)and phonic mmnb=(s)alongwith fi r=tffic dr(s)f officr than the msmnrance. Lm itedLiabilitY ComPames(L q orI.�dLiab�y`Patb=lEps.(LLP)wino �Iayees me t&=or parta=rs,are not rtgrmrd to carry worbms' cmmpan of iaa insmmce If an LLC or r.LP does have employees,¢policy is reg¢hed. Be advisedthat this affidavitmaybe mbmitind to the Department of Indnsbdal Aceideais for confianafinn ofmsormce covCra&M. Also be sure to sign and da-teithe affidavit The afda'vit should be refired to the cifyy or town that the application for tha pemtit or license is being request A not the D epartrnenf of dal A.c ' =,•t a Sbouldyou have any gnzVdms regatdmg fhe law or if you are required to obfsm a worio=' czmpcnm±c policy,please eaIL tho Depmtncz±at the rmmberlistE below. Self-fi sm-cd companies should eut a their s elf-insurau�o license mmnbw on the line. City or Taws Officials Please be sore$ the affidav is c=3pleiz and printed legibly. The Deparime�has provided a spacx�.thc bottom of the affidavit for you.to fll out in the event the Office of hmestig� has to you regarding the applicant Pleasebesnaretofllinthepra /IicensemrnberwhirhvMbeusedasart:f==conumber. In•add±Lc;3: maPPh� at mast Mbmit m�Ie p�iUHc:c ose applibafiCM in arty given year,naod only sabmit one afffidae cat that policy information(if n=essmy)and idea"Job�Address*tine applicant should wz�as l Iacatiaw in (OLS'err town)--A copy of the-affidavit that has been offiially stanxped or maziced by the cRY or to maybe provided m the " zzbL applicant as.�n oof that a valid affidavit is on file for f� �p or Hc=m A� b da�m b year.-Where ahome owner or rahzen is obfaTrr:ng alicensc or pr�itnatxe7at<xii�o anry Cie.a dog licause or peas¢to bum leaves eta_)said p=m is NoT rec=cd to filets thisaffidavit. The Office ofjUvcsfigsfi=wouldhlcc.to tbask you in.advm=foryour eo0pCX2Itian and:sbDrldyon:hav-my 4ncstow- plrsse do not hest to gim tis a call. i The Department's address,trlephpne and fax rnnabrd: - - CO=020��of Massarhu-Ats . 3me�t�flukAc�.id�n-tom Omce of InveStfkkti0= MA Oil 1I TeL.4 617-727-4M=ft 406 4r 1477M FF, FaxIT 617-727'749 xavisea4-24-07 gA ACOORE® CERTIFICATE OF LIABILITY INSURANCE OATE(MMMDIYYYY) 10/07/2016 THIS CERTIFICATE IS 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(ies)must have ADDITIONAL INSURED provisions or 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 CONTACT NAME: Heather Pearce Mark Sylvia Insurance Agency,LLC PHONE FAX 404 Main Street .No.Extl 508 957-2125 IAIC.Not:508-957-2781 E-MAIL ADDRESS:marl( marks Iviainsurance.com Centerville,MA 02632 INSURERS AFFORDING COVERAGE NAIC 0 INSURERA:Arbella Protection Ins CO INSURED INSURER a:Farm Family Casualty Insurance Timothy Gray Building and Remodeling Inc 68 K Nicoletta's Way INSURERC: Mashpee,MA 02649 INSURER D: INSURER E: INSURER F: 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE D POLICY NUMBER MM/DD/YYYY MWOD/YYY LIMITS A X COMMERCIAL GENERAL LIABILITY 9520 55279501 2/26/2016 2/26/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X❑OCCUR DAMAGE TO RENTED PREMISE a occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY❑PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000.000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Pe acGde l $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION S $ B WORKERS COMPENSATION 2001W6340 10/15/2015 10115/2016 1 PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER _- ANYPROPRIETOR/PARTNER/EXECUTIVE 10/15/2016 10115/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? NI NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000.000 If yes,descrbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Carpentry Timothy Gray is covered by the workers compensation policy. Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION (508)790-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor l &2 Fumily . License: CSFA-046234 , TIMOTHY GRAY- /• 68K NICOLETTV S W ". N ASHPEE MA 02649,� �l , )I �" Expiration Commissioner 11/30/2016 �. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only «] HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:. '102634 Type: Office of Consumer Affairs and Business Regulation Expiration: 7/2/2018 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 TIMOTHY GRAY BUILDING&.:REMODELING Timothy Gray �- 68 K NICOLETTAS WAY %i Mashpee, MA 02649 _ — _�� Undersecretary Not v without signature i * r T ' V Massachusetttts R Department of PubliSa�fefy r Board of Building Re ul ' J._ations and Standards i on ruction Supery sor.l.cY�2 Fa ni,'y .License: CSFA-0462U` TIMOTHY GRAY- 68K 1VICOL]E MASHPEE MA 0264 Expi ration Commissioner 11/30/2016 tPanvrizonuu a o eCla e Office of Consumer Affairs&Business Regulation ' 0' IMFR., VEME ' ONTRACTOR e T ! egistration: �� 34 y,;:,pe,:,. . Pr0!g,.,Corpo�atia xpiration• -_ I' ODELING TIMOTHY GRAY B6 . Timothy Gray - _. <R 68 K NICOLETTAS WA^1��/ Cam- ( Mashpee,MA 02649 .° Undersecretary L'ic:ns�or.registration valid for individul use only Gefore the`expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Not vali ithout sign ur ovaL l0/iyl q?�� ao/Yo60 F-3� Town of Barnstable *Permit# G Expires 6 months from issued e Regulatory Services Fee 2�2, Se •naxsrABt c. M"S& Richard V.Scali, Director )(A p Building Division WSS P Tom Perry,CBO,Building Commissioner RN��T 200 Main Street,Hyannis,MA 02601 OCT _8 2014 www.town.bamstable.ma.us TOWN OF Office: 508-862-4038 TAtt 0 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY LL _Map/parcel Number Not Valid without Red X-Press Imprint /�,�S (�Property Address � —�1t2d r91 \4 24- — [Residential Value of Work$S(L!1 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Am �1J�j�'t,� �7 (�Zk 4/!f!9, r Contractor's Name L X tl� l elephone Number 7rl—lW Z.-954 7 Home Improvement Contractor License#(if applicable)f/y,3 Y_-59 Email:ecooeA,eY t3L, o ��4d�fdJvt Construction Supervisor's License#(if applicable) lolr02-, ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor EVJ❑ am the Homeowner have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# O!9 — ,!,l 1�32.-22—/Y 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 E3'Re-roof(hurricane nailed)(not stripping. Going over 1 existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance 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 _____—_.------- - --requir&�& ed:`-- ----- ------- -------- _.—_ — -- — ___ _. - SIGNATURE: P/ At�_, Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 ► The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street _ Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ApOlicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: - .dam l Phone#: Are you an employer?Check the appropriate bo . Type of project(required): 1.El am a employer with 4' Uam a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' y p �'• $ 9. ❑Building addition [No workers' comp.insurance comp. insurance. re required.] 5. ❑ 10.We are a corporation and its ❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL. 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other 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. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have 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 thepolicy and job site information. J Insurance Company Name:� � Policy#or Self-ins.Lic. 6 J 222,—/y Expiration Date: 3/// Job Site Address: � 22 'l1J x- City/State/Zip: Attach a,copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 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 cent' under the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: J / Phone#: Official use only. Do not write in this area,to be completed by city or town official Permit/License# _ Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as".:.every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6 also states that."every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has`provided a space at the-bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to'fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to buns leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,teleplione,and fax number: � The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia Rightfax C3-2 5/30/2014 6:36:24 AM PAGE 2/002 Fax Server DATE(MId/DD/YY YYI CERTIFICATE OF LIABILITY INSURANCE T. � IFICATE IS 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- NDLIE CER71FICATE D IMPORTANT:If the cerlH(rate holder Is an ADDITIONAL INSURED,the policy(les)must he endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy;certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER CONTACT NAME: SYLVIA F COSTA DBA SYLV I PHONE FAX 15 MONTELLO ST (A/C,No,Mai: (A/C,No): E-MAIL BROCKTON.MA 02301 ADDRESS: 768DL INSURER(S)AFFORDING COVERAGE NAIC C INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA MAYANCELA,MANUEL DBA LKC CONSTRUCTION INSURER B: INSURER C: INSURER D: 254 N MAIN ST INSURER E: BROCKTON,MA 02301 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CrATIFY THAT THE POLICES OF 94SURAKCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REAUtRE 01017,TERM OR C<NtO MN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFOAOED BY THE oor vYES DEMM3ED HEREIN B SUBJECT TO ALL THE TEMRS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LOTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS RdSR ADD SUB POUCV EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (M=MYVW) (MISODIWYY) UMRS GENERAL UABIUTY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ CLAIMS MADE OCCUR. REMISES(Ea ocnarence) EO EXP(Any one person) $ ERSONALBAOVBWURV $ GENL AGGREGATE LIMIT APPLIES PER: FIJERAL AGGREGATE $ POLICY PROJECT a LOC ROOUCTS-COMPIOP AGG $ AUTOMOBILE UABILtTY COMBINED SINGLE $ ANY AUTO LIMIT(Ea acddenl) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per Person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ Per accdmt) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIIAS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YM U13-2E093222-14 031112014 03/11/2015 LEM ANY PROPERITORMARTNER/EXECUTIVE WA E.L.EACH ACCIDENT $ 500000 OFFICERIMUMER EXCLUDED? , (Mandarnry In non) E.L.DISEASE-EA EMPLOYEE $ 500,000 I1 yes,describe under 500,000 DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT $ DESCR(P_TION-OF-OP-ERA71ON5/LOCATIONS/VEHICLES/RESTRICMONSISP-EC(ALJTEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE MAYANCELA.MANUEL IS COVERED BYTHB WORKERS-COMPENSATION POUCY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT"YE Dgo are registered marks o1 ACORD 1988-2010 ACORD CORPORATION. Al rights reserved. l Massachusetts -De Board of Partment of Publi ilding Regulations c Safety Construction Su and Sta-ndards License: pe^'isor CS-101802 ARGIVELA'B Main Street 607N. , -. Brockton MA 02J01 �_p� s t a S Commissioner 4toi 0�05ration /2016 'Leg7Ig71472L(e6ll�fG O�(y�ul4 / .Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR gXplegistration: 1,63458 Type iration: :-6/22/2016., - _ _ DBA MIGUEL BARZOLA CONSTRUCTION MIGUEL BARZOLA 9-11 WEST PARK ST UNIT'.1 BROCKTON,MA 02301 Undersecretary • ,i ;,bL!fe,nse•orregistration'va`hd fo'c mdtivi8ul use only ' efore the expiration date..,If found.return to: Office of Consumer Affairs and Business Regulation jq.Park!Plaza-.Suite 5-170 Boston,MA 02116 d' q qt va d ho' Signatur I L HOME IMPROVEMENT SALES AGREEMENT 3 Webster Square HOME IMPROVEMENT CONTRACTOR REG#MA.177383 q REG#R1.37641 Suite #310 FEDERAL ID#46-4167378 Marshfield, MA 02050 REVERED 1-866-437-8868 . . M T L R OO FIN "Roofing for a Lifetime" THIS CONTRACT made the. day of n�, 20 betweenA-0 g (Homeowner) 7yv3 G/7 - 9Z-39a5' /-�; (Home Phone) (Cell Phone) (Email) (Address) (City) (State) (Zip) hereinafter the"HOMEOWNER"or"BUYER"and INVINCIBLE METAL CORP.hereinafter the"CONTRACTOR"or"IMC",with all of the foregoing parties being collectively referred, to herein as the"PARTIES".WITNESSETH:Contractor here�ya rees that it will,for the consideration hereinafter mentioned,furnish all labor and material necessary to install the following described work at premises located at P the"WORK".The word"I","me",and"my"refer to each person who signs as Homeowner.If more than one person signs below as Homeowner,each person shall be jointly and severely liable for the promises made in this Agreement.The words"you" and"your"refer to the Seller or holder of this agreement. AGREEMENT:I agree that it is my decision to purchase the goods and/or services described below at the Total Cash Price of$ I promise and agree as follows: 29 GLIAGE,THREE FOOT WIDE METAL ROOFING SPECIFICATIONS OF CONTRACT N :No surfaces will be covered unless specified. 1. Roofing Color: 4/ P- � OTHER- JDESCRIBE: ''D J� Total 2. '(dYes❑No Ridge Cap 'YVCJ �/V&,et (Jam�/ Cash � Price / !/ V 3.u�J Yes❑No Drip Edge 7K 4. ❑Yes a)4, Add Ridge Venting j' - ,�. i_ Deposit 5�} With 7 /l 5. Yes❑No 2"Exposed Hurricane Hardware Lin 16(z f �e Order 6. ❑Yes❑No Clean up all job related debris and haul away y I ,•� Additional 7. QXes❑No Chimney-Number of: `lm 7 P� /JA -� Deposit y� 8. �i'es❑ y1wG No Flash Pipes-Number of: G!' EXCLUDED: Due Date:C �i 9. ❑Yes[]No Skylights-Number of: G �/ Balance Due NJ ., 10. Yes❑No Valley �4� - ,�� On —/ / 17 Substantial J WlJ Li & 7� Cow 11.�es❑�No Rake Trim Endwall Sidewall 12.❑Yes 62'No Remove Vents 13.V(Yes❑No Ridge Closures C)&44ve,� JOB . SIGN OK 14.111 Yes❑No Remove&Dispose Gutters Proposed Start and Completion Schedule: '�,�y J� r �j��. /Q(� ,`/W i(,2 1�3 /OA/ -116 vv�_S date when Contractor will begin contracted work. date when contracted work will be substantially completed INVINCIBLE METAL CORP.does not do any painting or staining and is not responsible for conditions or circumstances beyond its control including condensation resulting from or due to pre-existing conditions 'fro N• ,_ c� e1ve.LJ+T1- 0. INVINCIBLE METAL CORP.is not re sible for stripping any roof material prior to installation.Note:Fascia trim or strapping is not included unless specified 9ash• ❑ REVERED METAL ROOFING Assisted Financing ❑ Debit/or Credit Card PROMISE TO PAY:I promise to pay INVINCIBLE METAL CORP.,the Total Cash Price prior to or on the date of substantial completion as agreed to herein.If payment is made .by credit card,.:understand that I may only'cancel,reverse,or dispute the credit transactions within 3 days,and thereafter all credit card transactions are valid and enforceable. BINDING NATURE:I understand that this document does not constitute a valid and binding contract for any purpose until and unless it is signed and accepted by IMC. You may cancel this agreement if it has been signed at a place other than the Contractor's normal place of business, provided you notify the Contractor in writing at its main office or branch office by ordinary mail posted,telegram sent or by delivery not later than midnight of the seventh day following the signing of this agreement.See attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies of the contract must be completed and signed. One copy should go to the homeowner.The other copy should be kept by the contractor. IN WITNESS HEREOF,the parties hereto have signed their names this day of�_�20 I 7 h_ Signed: ' MARKETING 6EPRESENTATIVE o HOMEOWN R-- ACCEPTED: Signed: OFFICER OF REVERED METAL ROOFING HOMEOWNER Notice:The terms of this.agreement are contained on both sides of this page INVINCIBLE METAL CORP.Copyright©2014 i Assessor's map and lot number.-,..... , ..j,. c�THE T Sewage Permit number ...............1....br.....'p.......................:...... Z BARNSTADLE. i A House number ........., a. .................................. . r rasa Apo,2639. TOWN OF BARNSTABLE BUILDING INSPECTOR. APPLICATION FOR'PERMIT TO ...... ..............) K .1. ...yl .................. TYPE OF CONSTRUCTION ...... . .. J.. ............................................ ...................L4... ....� .................19�� .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location/O .al. �. ....✓ ....�/.�11�G....'....... 1�. ��'.. - Proposed Use ............................................................................................................................................................................. Fire District Zoning District ..........p(�T.,...�......!....................................................I Name of Owner ..1C�r,bw, :3...Y...... .� �`,•�.:.�.c. �.r. Address ...:(�... ► (,a,�,c1...<.?!:.....1�..!. �s-i-cn�. .�..V.f.. .. ; Alj ..�..I \`- �,41.s^ �,. t� �tii ! rt'�t� w 11 r r�(c lei /........ Name of Builder .. ..:............ ..... ...,.:..........Address .................... ......... .......... .. .�........� .. .. J Name of Architect 1C;(c,��<x�. ?.........�r' cGir.4. ...............Address .�rs�*.,,J7r??�...:... t-,. /Y, wr� Y..„l,fl ..• � I J Number of Rooms ....................................Foundation ��sv.q.w..�!..... .,,:..s . Exierior .. :. .rt �o�. ,, \!..5�.:k.e.................. .J �... ........ � ..... Roofing ..,.�. C,.�;i ,vN 3................. Floors � �d.Y=: ...ac�c, ,c -l..td......�.�.................... Interior �.'�.. 1 r%�._#......\..4....S.....Y ................ f1 Heating .. " �..0 , .... ........................... Plumbing ....... .. ......,�a oc................................. Fireplace ..:. . .a.�j;.. ..<..Y....................................................Approximate Cost .............:. �G, CX1c� Definitive Plan Approved by Planning Board -------------------—-----------19--------. Area ......` `�� .`..'..... .... '. .. " Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH TIC �ld-177 ". a f ti ti i 7 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............ Cunningham, Robert7,37-"AA=55-37 No ......21274 Permit for .....one story........... ...........single...fami.ly..dwelling........ .... ......... . . Location .............522 Cotuit )��y..P�Kive ......................Bay..Drive cotuit . ............... ............................................................... Owner ...........Robert.-J-.---Cunningham........... Type of Construction a...frame ............................. .............................. ................ ............................... Plot ............................. Lot ........... .............. Permit Granted ...........Mdy. ..a.................19 79 Date of Inspection ...................... .............19 Date Completed .................. ...................19 PE 1T REFUSED ........................... ..... 19 .. ....... ...... .......... ......................................... ..................................................... .............. ................ ......... ............................. v .................. ......................... ...................... Approved ................................................ .19 ............................................................................... ................................................................................ *snn log z 41W2123341 of �.r+�v'�Y'1ddV aas� �Q 1on aIc�ors 3T+.l 11.1•ans S�S•vvy 4ntnla__3lso trrgwc►alJ;"i nv Ttio Q9Sv$ IOT1 471 r+v'16 Sail Yaol.3nacr5 cirrv't cim-m misi-mg ••�r,� �1`.r~ ;� a��.x,a a �.va LZ ' 7d Zb2 '-Aa 'ldjo rArACa 1 5, and S-x - ter+�'�3al�i. -3".L ".Lim r"Crsl •i hrrbMS N4�,�.'�/GL['�n� �i-+1 1dfi11 1,�t17a7 1 TL i b'b8 �n cus S a9ms" - ;• tU.tM � *7 °d nm:Y •nnt 1 ••• •rn�u N+� •-1ba1Lb vT5 ttMt 1S1a sas�fi -►+o�ci� p'�.. nrn !': not 0051 �d'�.•� `"ti°1 ='7 J 'mart tt le CdAp • �- r+9�S3n '�bf1o1 no rid =�s 1�1 CzLd-,!P zlt $L �i 801 = v9av Tyrc�►� G3F ,Z/ ax,I �*n 1�a -lvsodi5IG '"71J9 09*9 1 '-3 S a•d•'aK ,>o-x r oft = ��.a ), iOD j 4 1 ..its 0 fir+art- 9'Y?Q2'V9 vi ll m W00 -7 - �,-1 t Vvtr� �17 t ►15 + oo•oL�?:a • roe + I r f i �� ltiQ 1-1-Y cri 10 it Assessor's map and lot numberG-� /... . c°.. ........ O yTHE Sewage Permit number ......... ......................... SI= 'TIC t°�Q �♦� 9'p INS"7 F. AUSTODLE, i ` House number ..................'. ....`_..:+ '._:....................... WIT ARTI rb e r� SANITARY L' fATE 'FOYAYa�e '' TOWN" ;OF BARNS Ai6{ BUILDING, [N PECTOR APPLICATION FOR PERMIT TO ... .....................................C`- ................ . . . ......r. ... TYPEOF CONSTRUCTION ......... .. .. .. ................ .............................................:............................................ 2f.r ................ .............G........19 TO THE INSPECTOR OF BUILDINGS: _ The undersigned hereby applies for/aj permit according to the following information: Location ......... ..0.1........c� .....1..... '. iLl.i,.. . . Val .!..........1_...G �1. :.t.......................................... ProposedUse ... ;.... ...................................................................................................................... Zoning District .....................yr2.....4.....................................Fire District ........................... . .. Name of Owner ...: ...I:. . .. I,,;�.'I j. 6,t. c bA4Addre s♦.... ...—....!/.../.�1�!k�r..I .. . .� ...��, Name of Builder �� 1�. ... �'.4� Address � /`Z! f'C�� ..`. .�.��✓7/��'��r� /t / Nameof Architect .............................................../...................Address ................. ............... ................ i..........................!.. Number of Rooms ..................................................................Foundation .... �. 1 ..."... .... ............................ Exierior .....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace .................................!................................................Approximate Cost ... ......:............................................. Definitive Plan Approved by Planning Board ---------------_—-----------19 . Area .... Diagram of Lot and Building with Dimensions Fee /� SUBJECT TO APPROVAL OF BOARD OF HEALTH I .j I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. t Name ,. . ................................. Cunningham, 1obeztJ, ' ^ � , 2l24�. ...... nonl ` No ' . Pern+� for --..��������..���.r —. — ^� , ------------.. / ' x ` =Cotoit B�v Location ........................... ' ---------. �------------. ' ' ! J. � Owner -----�>����!�—.�..������!8����—.. ' . Type of Construction -------..------. ! ~ Plot .`-------- Lot ----------' ' '^ 27 Permit Granted ---- � -----lP 7� - ~ - ' . . Date of Inspection ...... —lV ^�~ . Date Completed ---.��0��r-----..lg PERMIT REFUSED ................... lV ' . --------'--.---------------.. ~ ' ` -_ ---.—.,^.—�.~�----,--..-------.. . //— ---..�. ............................................. ------.�—~—.—~---.---------.~ . ' ' .`,^...-----------.. lQ` ' ' ._------.----.---.....--.—..---. ` ................................................................................ .^ | 77 As 'A" map and lot numb ............ cc. uL?TIC SYSTEM MUST SE �Of THE TOE 9 >> INSTALLED IN COMPLI Q o Sewage Permit number ..............`...�lJ....... ................ WITH ARTICLE II AN STATE A�+IAR 2 BABB9TADLE, i House number .......... .�. .`' -................................. RA ARY CODE AND TQ 039. o MU& �Fa YPY a� I TOWN OF BARNSTABLE BUILDING ,INSPECTOR APPLICATION FOR PERMIT TO �, / �: V .......�. 4!�.S �.....:...:!.`'K./�...... ...�`�.�`�.f./ 5.................... TYPE OF CONSTRUCTION .............. ................................. ........................................... ................:4.....�..................19..'./.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location C/� � �D ! 7— �/�/. !�1 l!c — �Q ..............................................................I .. .. .... .......... ................ ........................... ... ... . .. . ��6 I d e �. c� Proposed Use ............. ......... ..................................................................................................................................................... Zoning District ......... . ..................................................... ......Fire District ........... CU. 4�.t...l r ` . ........................................... Name of Owner .. .... .v':r�..V„ cave �.►ti .. . Address ...u�lv...C..'.}.a! 'z....S:r.... 11.!.!'��5 .�..f..".4. .: ! I_ I' U . Name of Builder ... Kl.'�.�...�.l:..�c-S,!!t.�!!a . .. �A.!�!:�.Address .............��l.rl,..C.J."�,....j\..�.F`��4....�.�...1..:'1..:�.: I_ RX4� c CJEir .............Address ��. � f- /�rF!Name of Architect . . ....... ..C'..........�. ..�Ll�.tK....5�1.4Y.!...�.... ............�.�J...�.!.F.. :.'.... Number of Rooms .......................7...................................Foundation ........ . � �c,.-.,.1Y.rJV................ Exterior ... ..... .. !.. .!.��...................Roofing ......., .�Ss . ` ........ ........... �1 1 •I-��4Yz�w� Floors c��.4!CSo..crc !�d-��?.� �1.` .....................Interior ..... . S�Y .................................... Heating I..,..f!.1 �.......�1.'.—..............................a�.....Plumbing ........ ..:.Vs.�.�..........��' cn' �?.ti............................ Fireplace ..:.1 . ,l. ``.!G ................. ..............°................Approximate Cost .............. j.a0 ............................. .. Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....... ... ...... `...... .... Cunningham, Robert J. ll,4j21274........ Permit for .........One ........ story...... single family dwelling ............................................................................... 522 C!�it Bay Drive Location ..................... ........... ....................... cotuit ............................................................................... ��g ........ Owner Robert J. Cunningham......_ Type of Construction ..................frame........................ ..................................................................... .Plot ............................. Lot .......... 25............... Permit Granted ............may..8.................19 79 Date of Inspe6tion ....................................19 Date Completed .............. ...............19......... PERMIT REFUSED ................................................................ 19 .................................................. .............................. .............................................................................1. .................................................................. ................................................................................ Approved ... ............................................ 19 ................................................................................ ............................................................................... Assessor's map and lot number .. ... . �'.... � fii� J{- 'i /r Of TME.Tp Sewage Permit number ........ ...:..:.:.........., �`� ♦�.... .,. Z BJHBSTGDLE, i ��I House number .............................................. .........:...:...:::.:... q MM6 pp t 63 9. •FO N p. TOWN OF '.BARNSTABLE BURDING . INSPECTOR APPLICATION FOR PERMIT TO. ...;,.:...................................:.....:.. ,.C.0-C�t -c�•�•� a �_n ,�J..i s� .� TYPE OF CONSTRUCTION :.............. ....... Y.............................................. ............. ......... ...`f .........i92`I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordinng� to the Pfoolllowing information: Location .......... ..., . .,tl,7l/l..c..........`...L..�'a ................................................ Proposed Use ®.\.!lJ,/.�i, L-..... ...........J...:............................ .. p r� Fire District . Zoning District ...................... ................................... ................ (c 1l ;Q,,.t, ; �.('�t,». .,i�;..�ih,rAddre sG ,�/t�iz� ? ,c. ��.�, . Name of Owner .... .. ... .. � ,. ••••• •• •..• .• • ,��° fl fL/ .e L ?" Address , i;� v��� ; ? Name of Builder .. Nameof Architect ...............f.............................�..................Address ..... .................................................................. ..... Number of Rooms ........................... Foundation ..................................... �. ..... • �r Exierior ....................................................................................Roofing .............................:. Floors ......................................................................................Interior ...:................................................................................ .:..Plumbing Heating .............................................................................. .....................:........................... ............................. Fireplace ..................................................................................Approximate Cost ... r .! .: ......................................... Definitive Plan Approved by Planning Board -----------____---------------19_______. Area ........................................... Diagram of Lot and Building with Dimensions Fee .... . ..�.............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................................ ,. . -0" �' � ' , Cunningham, Robert J. A=55-37 21243 ' --------------------------. Cotoit Bay Location . -�^ !���!��—. —.. _.. _______ .. T7-- � - Cotoit- ----'---------------------- Robert J Owner ---------..�— --_. � ' Type of Construction .......................................... � � . ' --------------------------. � Plot ............................ � � � - GrantedPermit� Date of Inspection Date Completed � � , ' � . � � " ' '-----' —' ------ ---------- - . � ......................... ---------.. . 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I it1 xT� ;`.i]�t v'��9T(�P ?,n;�'c T�d't�dsr d'N rs'vaZi'Ta�Egj�„' ' `Y`' s1:a� �•,i,.• f�' !,, ♦c � �`->Y C+O �(WQ��.6.t1! �fi+f lq..�)•`_f.'19 `A{A�]R 'DFA � � �r„�� yen � � S.� ''�'• W- ut � , � f •�� �__ . 4 ON.N CONS ; LOCATE JLf[i3 FOUIPMCNI' $KIM,ER.t?rRETUFlNy i' C 0. CIA :SpECIFICATI0P15 N EQUALIZERS < s! CHlOi11NATOn.. C• $ S RDS:CROOK tDEPTH MARKER HEPHE MAIN DRAINT},} . VALVES —� TURNOVER, • la,�, CAPACITY ':pals r..•. , Goner— al Plotes ,-.• " � Electncel qas and',lence work by other P00UI REA TO OF > Heater venting 6y ptl+80. ,FEN D.PER COUNTY g Up to elpht.hqur pool el{Cavatlop allowance.. pl�'C TY OADINAN4E,.. OAT S tO BE vELP 4"!.'-Additional.Work 6y gddendumpnly CLOSSNG'ANDSELF: DATA DFIAWN. . CHECKED LATCHING• SALESMAN" gY fBY.OWNER ''DRAWN BY AME. l'r47 ... .. - N CITY.•• -•'r r STATE � 'i zip CODE RC•S.PNONQ2 JOhEf_ 1 DIRECTIONS z WET D WN COHrI ETE Sf IELL.AT L•EAST.TYVICE DAILV ON 14 OAYs I DO:ryOtttttt TURN QN POOL LIGFIT.WHCN POOL IS EMPI Y - , � •' ' DO NO�JSE RU}gER'HOf C WNEN'PILLINC �r� POOI A{SITWILLMALASTER' t,, 4u it r Fe Pbc ' „. EQUIPMENT DF A.EMI T� ., a ' 42 Turnpike Road a Rt. South oro, Mass. 01745 Y SPECIFICATIONS St-T BACKS SiZE/<- RONT.,�,- SIDE , � ' SHAPE PERIMETER REAR .__ I3I. DGS;__ TILE 17A ..��.__ COLOR FILTER P OWNER TO DETERICAIN HEATER APPROXIMATE ELEVATION SEPARATION TANK AS NOTES! OR ESTABLISHED ON EXCAVATION DAY' SACKWASH MAIN DRAIN W/HYDROS'(ATIC RELIEF VALVE GRADINGi SKIMMERS RETURNS AFTER UNIT LIGHT SHELL LIGHT LAC3Ir3ER ._.....�.._._.,_,_.a... HAURAML�___..._.�.� .,.. REC,F<,"SFL) S-T-E S GRAB RAILS ROPE & FLOAT I`'L L OR STONE BOARD SLIDE BROUGHT TO " SP A BY ADDENDUM STUB OUT PUMIPS DECK WORK NUMBER USED CANTILEVER FORM fiNTED FROM COPING STONE 4,y 0THCR 6 AC -., fi WATER ELECTRICITY j : , 7- CONSTRUCTION NOTES LOCATE FILTER EQUIPMENT r SKIMMER & RETURNS ";L COMMERCIAL RCIAL. PECIFI ATIONS EOUAiLIZERS CHLORINATOR DEPTH MARKERS SHEPHERD'S CROOK MAIN DRAIN VALVES TURNOVER CAPACITY gals General N ates. s POOL. AREA TO BE 1. Electrical, gas and fence work by others FENCED, PER COUNTY 2. Heater venting by others OR 0' TY ORDINANCE, 3, Up to eight hour pool excavation allovwdnee. GATES TO BE SELF Q. Additional Work by addendum only CLOSING AND SELF --- R LATCHING. SALESMAN DATE DRAWN CHECKED LL_ BY OWNER DRAWN BY BY 11IAME ``..,��� ADDRESS.="--'.:F CITY. : __ STATE. e- _ ZIP CODE RES. PI-lONL" _ BUS.. . PERMIT'tt—INSPECTOR,—JOB l OWNER: DIRECTIONS WET ®OWN CONCRETE S414ELL. '%T LEAST TWICE. DAILY FOR 14 OAF'S DO NO.,, TURN ON POOL. LIGHT kIIHEN ILL IS EMPTY. DO NO USE RUBBER HOSE WHEN FILLING