HomeMy WebLinkAbout0009 TANBARK ROAD �� ��
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Town of Barnstable *Permit#.-;'M-76 $�
Expires 6 months from issue date
Regulatory Services Fee 4. 66
Thomas F.Geiler,Director
Building Division ;
Tom Perry,CBO, Building Commissioner ?Oro
200 Main Street,Hyannis,MA 02601
www.town.barmtable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number 0 S!' n S7
Property Address `0-a. C t Acywm w m, mt�1n
[aResidential Value of Work �.,6�CI�• Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address Mk V--L 9 I�Gt M W p,1T7M.
n\
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) acn
❑Workman's Compensation Insurance X-PRESS PERMIT
Check one:
❑ I am a sole proprietor DEC 2 7 2007
❑ I am the Homeowner
I have Worker's Compensation Insurance TOWN OF BARNSTABLE
Insurance Company Name A;; 5G 6°tAOCIZ-' gm PW r
Workman's Comp.Policy# Kj Si L400('0
Copy of Insurance Compliance Certificate must be on.file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
Replacement Windows/doors/sliders. U-Value 0 A-c)-- (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. -
***Note: Property Owner must sign Property Owner Letter of PermissJ4.:6 WV L Z 0,40 LOU
A c y of the Home Improvement Contractors License is required.
iIGNATURE:
�Torms:expmtrg
tevise061306
' The Commonwealth of Massachusetts
e' Department of Industrial Accidents
Office of Investigations
600 Washington Street
i Boston,MA 02111'
www.mass.gov/dia '
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluimbers
Ap1plicant Information Please Print Le ' I
�• — Es.�t-di fJcJ�[ Vlir•c j� (�Rel� '`
Name(Business/Organization/Individual).• ,-
Address: 0 x qaq
City/State/Zip: C`RUy�l�'� �fk G�3 Phone.#: �'
Are you an employer?Check the appropriate box: :Type of project(required):,
1.[�I am a employer with 4. [] I am a general contractor and I
employees(full and/or art time
* have hired the sub-contractors 6. ❑New construction .
2.❑ I am a'sole proprietor or p on the'attached sheet. 7. [t�,Remodeling
ship and have no employees These sub-cofactors have g• Demolition'
*orldn for me in an capacity. employee$and have workers'
g Y P tY• 9. ❑Bvs1dmg addition
[NO workers' Comp,insurance comp.manranCe,
required.]
5. We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all-work . officers have exercised their 11.[]Plumbing repairs or additions '
myself[No workers' comp. right bf exemption per MGL 12.❑Roof repairs
insurance.required.]t c. 152, §1(4),and we have no 13.[]
employees. [No workers
comp.insurance regired] (�.e (Art a�-{'e >LJI-„
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Honmwnas•who submit this affidavit indicating they are doing all work and that hire outside contractors must submit a new affidavit indicating'such.
tC=b=tors that check this box mutt attached an additional sheet showing the name of the subcontractors and state whether ornot those entities have
employees. 1'f the sub-contractors have employ=,1hey must provide their workers'comp.policy number.
I ani an employer that is providing workers'compensation insurance for my employees. Below isthe policy and job site'
information. ww!!\\
Insurance Company Name: ��Ct ( �-j- pt[�./�/LS �-♦-'6
Policy#or Self-ins.Lic.# u Cp—��� ��� i ��' _ Expiration Datet1 t^J Y>
lob Site Address: ��`'� '� V[��C City/State/Zip:
Attach a copy of the workers'compensation policy declaration page'(showing the policy number and expiration date).
afoul
Failureto secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine rip 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 maybe forwarded to the.Office of
Investigations of the EIA for in urE=e coverage verification.
I'do hereby,certify under the pains•and penalties ofperjury that the information provided above is true and correct
Si afar ��� Date• e- 3'U _
Phone#: XG-�7 l✓
Official use only. Do not write he this area, tb be completed by,city or town.off�cial
City or Town: ' Permit/License#
Issuing Authority(circle one):
J.Board of Health 2.Building Department 3,City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
I r
o�t"�rati Town of Barnstable
Regulatory Services
r a
r
• iARNSfABI.E,
MASS. Thomas F.Geiler,Director
i639-
AIEDMA'IA 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, r`��L� Nit�� , as Owner of the subject property
hereby authorize J�F�ti • ��ol t'—) - to act on my behalf,
in all matters relative to work authorized by this building permit application for.
(Address of Job)
Signature of Owner Date
14 c K.i= tkrcF -.,
Print Name
If Property Owner is applying for permit please complete the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:O WNERPERM ISS ION
r
oF r
Town of Barnstable
zl�
Regulatory Services
BARNSTABM Thomas F.Geiler,Director
9 MA-S&
1639. .• Building Division
rED �s Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER':
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"bomeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to
be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shalt'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
I
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors;Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
I
DEC-06-2007(THU) 16: 00 MALCOLM & PARSOM5 IM5URAPICE (FAX) 17813441425 P. 0011002
�-0.BA , CERTIFICATE OF LIABILITY INSURANCE U/06/20o
PRODUCCR (781)344-3200 FAX (787)344-1425 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Malcolm & Parsons Ins. Agcy. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
6 Freeman St. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 527
Stoughton, MA 02072 INSURERS AFFORDING COVERAGE NAIC a
INOuReD 30 n Dunn INSURCRA: Associated E111{7loyers Insurance
DBA: Sohn Dunn INOURER8:
P.O. Box 924 INSURER
Centerville, MA 02632-0924 INOURBRD:
INSURER
COVERAGES
THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING
ANY REQUIREMENT.TERM OR CONDITION OFANYCONTRACT 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
POLICIEG,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
I bR TYPE OF INSURANCE POLICY NUMOAR CY 2PM OTlvp POL t9i A7 ON LIMITS
ORNERAL LIABILITY CACH OCCURRCNCC S
COMMENCIAL GENERAL LIABILITY AMAO O WT S
CLAIMS MADCs M OCCUR MCD IOW(Any onv pateon) S
PERSONAL I&ACV INJURY $
OCNCRALAOONCOATC S
OI NI AODREOATe LIMIT APPLIES PM, PRODUCTS•COMPIOP AOO S
PDut:Y 7jG-aT 17 LOC
AUTOMOBILE UADIUTY COMBINED SINOLE LIMrr S
ANY AUTO (Fa aacldanl)
ALL OWNCO AUTOS BODILY INJURY
SCHEDULED AUTOS Uxarpamanl s
HIRED AUTOS BODILY INJURY
NON.OWNED AUTOS
PROPCRIY DAMACC S
Q•Vr eccldena
OAItAOR LIABILITY AUTO ONLY•CA ACCIDCNT S
ANY AUTO OTHERTHAN 2A ACC S
AU'r0 ONLY: AGO $
EACE=UMBRCLLA LIABILITY EACH OCCURRENCE 9
OCCUR ED CLAIM9 MADC AOOREOATE S
S •
06pUGTiDLC S 1
RETENTION S 1
WORKERDCOMPCNOATIONAN13 WCC5004658012007 09/29/2007 09/29/2008 X wl:yr tu. O M•
EMPLOYERS'LIABILITY IiL LIACN A GIDpNT S 500 000
A ANY PRON- 1E1ORIPARTNFRIh7t6CUT[W5 s
OFFIC8RIMWMBUR�CLUD6D7 G.L.DISQAS`.GA 5MPLCYC. S 500,000 ¢
tt�p deecnl»undar }
tiPCCIAL PROVIOIONA below GL.DISEASE•POLICY LIMrr S S00 000
OTHER
DESCRIPTION OF opERATIDNO/LOCATIDNST veMICLb71 rXcLusIDNO ADDED BY ENDORSEMENT I Opt:CIAL pROV1810N9
reentry Contractor
ohn Dunn is covered by the Workers Compensation policy.
RTIFICATE HOLDER CANCELLATION
SHOULD ANY OO THB ABOVE 048CRI000 POLICIES BE CANCELLED BEPORB TMC
WIRATION DATC TMCRCOA,THE IOOUINO INOUPOR WILL ENDCAVOR TO MAIL
Town of Barnstable DAYS WRITTEN NOTICE TO THB CERTIFICATE MOLDER NAMED TO THE LET,
Building Department OUT IAILURNTOMAIL SUCH NOTICE SNALLIMPOeENOOSLIOATIONORLIAOILTTY 1
Main Street OF ANY KIND UPON THE INOURER,ITd AGENTS OR REPRZaGNTATIVBS.
Hyannis, MA 02601 AUTMDA=DRCPRESENTATN6
11rving Parsons J�
ACORD 25(2001/D8) FAX: (508)790-6230 OACORD CORPORATION 1998 °
e
o� r�.
lu Ito o(d?Iikre�2� in4 and S�1 a ura �:..
— iMPROVEMEIVTCONTRACIQ1t
eyrstratro '
/ Exprr tea; 6/75/2008 ;7
c f _ �tnoiuidual
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P. uu.NN
.. ;-phn Bunn
3(?"AP{E�,J
U.
TERR,. 1i
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N i (ZV :E, MA O�fiB
:.: Deputy Administrator
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C :ter et Y V
....i [w�� _,."m„-:.,;fir.-".� .,+t>..,, •,..�-,.�> >., :f:"�,y,4 ytl=�l;�td.� �•�i..r�..u-...�.;�i+::'.ir Y:::���'��"1:.�"j[ C .:_`.:�, -.ti:.: �:-,.'�
Assessor's office (1st floor):
THE
Assessor's map and lot number •` ....J...... � F TOE`
Board of Health (3rd floor):
Sewage Permit number ....4�................
J
NABEngineering Department (3rd floor): �JS 'oo 39• e0�
House number ...................................;..................:l.................
'fie rar'.
Definitive Plan Approved by Planning Board ------------------------_-------19________ .
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00-P.M. o'hly
TOWN 'OF BARNSTABLE
BUILDING INSPECTOR
pNSTiZOCT SEC C
APPLICATION .FOR PERMIT TO ............................. .............................................................................................
TYPE OF CONSTRUCTION .........�. ,(A/1r.0 —1 /�/� - c L/ G�Uo/�.......... � �ME
....... .�.. .............i. .................... ...............................
`.'.2....C2. ... 19.0:.
TO THE INSPECTOR OF BUILDINGS:
.The undersigned hereby applies for a permit according to the following information:
Location 4 67 /06 T.o�/�3A(�K gU,91) /U�i�S7�Ns /<-f C �
....................................................... ............................................ . . .....................................................................
Proposed Use �.J/ ^,6-C€
�M1c y ...............................................
Zonin .......................................................................District Fire District ...... ..
Name of Owner ........cp1Z ....................Address
....................... ...............................................
n. Name of Builder .....SA �f..................................................Address .......S.QM.F................................................................
Nameof Architect ............_..............I........................Address ....................................................................................
J ......................................................Foundation .......(iY..�P�.......�...��� .�F...............................
Number of Roomss':...: . .' � � �� li
Exterior ......e L��-5
r.............................................................Roofin 5... i1?[ l
g .............. .....` .... . .......................................................
Floors �A � �V��,�C Sued /IZ0�1�
Interior ....................................................................................
Heatingg ....................................................
Fireplace ....✓.P......................................................................Approximate Cost ... ���f.G.. :Q. �Q.....................................
s
Area ..........................................
Diagram of Lot and Building with Dimensions Fee
3c?
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ... . `..... , .g `....... .....................................
Construction Supervisor's `License ..... *.���.:.'.��................
GREENBRIER gORP.
- ' s7 091- a57✓
No ..32550.. Permit for ..1 Z....St -qU............
Sincrle Family...Dwelling.......
Location -....Lot...#10 6.1..... 9.,.Tanbark Roat3
Marstons Mills
Owner .Greenbrier Corp.,..................
..........................
Type of -Construction .Frame -
t
...............................................................................
Plot .....:...................... Lot .......................:.........
Permit Granted .....January...10,,.,.,..19 89,
Date of Inspection ...'.................................19
Date Completed ......................................19
.i
i
o_T TOWN OF BARNSTABLE Permit No. . 25,5,Q......
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash
.Ml /yam
•��O6jY `
u HYANNIS.MASS.02601 Bond ....���
CERTIFICATE OF USE AND OCCUPANCY
Issued to Greenbrier Corp.
Address Lot #10 6, 9 Tanbark Road
s
Marstons Mills, Mass.
USE GROUP FIRE GRADING OCCUPANCY LOAD
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
........M.aY..25!......... 19...89......... ....... �.. ....
Building Ins• ctor
DWN OF BARNSTABLE, MASSACHUSETTS
BUILDING' ; IVI1`T
A-099-056 & 057 .fajay.lry 10 85 ��Tl�a 3255
DATE 19 PERMIT NO.
!PLICANT O47T1E?Y
ADDRESS Vv.L J7 '
(NO.) (STREET) (CONTR'S+LICENSE)
=RM1T TO Build dwellin .''.f Si—n��le ]'F,;'TIj,2)+ dwelling NUMBER OF
(_1 STORY 1�•
(TYPE OF IMPROVEMENT) NO, DWELLING UNITS
(PROPOSED USE)
lot IilUb 1T (LOCATION) 9 TanbarkPoad, 'Iar.storls ?,ills ZONING tRF(NO.) (STREET) DISTRICT_
I IETWEEN AND
(CROSS STREET) (CROSS STREET)
I
(BDIVISION LOT
LOT BLOCK SIZE
I
GILDING IS TO BE FT. WIDE BY FT, LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
1 TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
r
' (TYPE)
'AARKS: Sew,i,ge. 1/88--753 Appeal #198b-68 Marscons '.icls ldoodlap_ds
1
r ,
N/A.
/1 OR 168 riq. it. 45,000 b1:50
IUME ESTIMATED COST $ FEE
MIT
)CUBIC/SQUARE FEET)
Grvenbr:ieT: -Corp.
HER
V:, iV r_ IL1:: ...i.: . �.
� :,.F. :_,I.J;_ BUILDING DEPT.
IRESS 11 • c BY
I
(
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.`T'7CT+'T"Wl'1:71t7'TJ�'P'U til"L"It`W 017"K S---"1 FfE"'IS"S1TA'fJ"CE"O'F'Tlil'S"p'ER'M fi"(jp E'S'"FT'O.1• RELEASE THE APPLICANT�IF ROM, H TE CONDITIONS MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR
ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR
I, FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL I NSTALLATIONS.D
;.•PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MEMBERS(READY TO LATH).
J, FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE,
OCCUPANCY.
POST THIS CARD SO IT IS- VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS
— ELECTRICAL INSPECTION APPROVALS
1 i 1
IMF ��a• 1
2 . -- —
2-�.�.� PAa • 2
�G
HEATING INSPELfION APPROVALS ENGINEERING DEPARTMENT
.�/ Yl,
OTHER
` y , y,- BOARD OF HEALTH
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'W!LL BECOME NULL AND VOID IF CONSTRUCTION
TOR HAS APPROVED THE VARIDUUS STAGES OF 1 W O R K IS NOT S T A R T E D WITHIN S I X M O N T H S O F DATE THE INSPECTIONS INDICATED ON THIS CARD CAN BE
CONSTRUCTION. PERMIT ;IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE ORWRITTEN
NOTIFICATION.
f - -
o �
OPT N /
GPI `3
R = 16.00'
pp �� L 26.82'
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1 1 9 INITIAL ISSUE PAL
N0. DATE AESCRfPl10N BY
AS-BUILT FOUNDATION PLAN-LOT 106
MARSTONS MILLS WOODLANDS
N
BARNSTABLE, MASSACHUSETTS
os WOODLANDS ASSOCIATES REALTY TRUST
SCALE V 30' JOB NO. 13W,4.
I CERTIFY THAT THE FOUNDATION o
PAUL A. ',, 0 50'' 100
SHOWN 0 LAN S OCATED - LEvv 1
+ ON:THE D.:'.A DI ATED No: 1G617.
LM RAM vim
��y�f.1AM ill.
A REGISTERED LAND SUR YOR `_'J��� °®' L °am= " M u>•�
889 Tress luar snmu CZNMU = MA 0269E
Assessor's office (1st floor): i ��C SYSTEM MUST RE OFTHET°
Assessor's map.and lot number ... ... ...... ��!�!.>��7 1 , a:.� .�9 ,� ,E
Board of Health (3rd floor):
Sewage Permit number ... .-73... �. " �. ��a '�' '1
► I IAA STAMLL,
Engineering Department (3rd floor): �_ ENkiI,ONMENY�L CODE- '-� rues
House number ��......::JS. ' TOWN VAG "TIONS °°,o,i63I
.............................................. CFO YAY
Definitive Plan Approved by Planning Board ----------/_° �0.______19 .
APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only.
TOWN 'OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ...... a . (,.JEC L Z!!I.
...........................................
TYPE OF CONSTRUCTION �tti ................ /0 CY �Z� F
/a....a.................19 �r.
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location �6T /0G �On/J3AK.rl.........��UN�� ,ti/.oi<j70NS -/ILC�
............ ............................. �................... ................................................................
Proposed Use $3n/G cf- !! - L
Zoning District ........................................................................Fire District ....................................et
...................
Name of Owner TZCE�$lL1C� cofZ� �Q � S/d v7c`Y�'V.1 LL�
.................. ... ....................Address ........ ........ ................:....................................
Nameof Builder .....Sp.�F.................................................Address ......SR.!K.Cc................................................................
Nameof Architect .....'.....................:....................................Address ........... r........................................
Number of Rooms ..................................................................Foundation U..ZEI 6 C�Cf�E
Exterior ..... L� .S SN1%v(�G�$ - cA�
... ..................................................:..........Roofing
.... . . ....................................:...............
P
Floors .........c.q/� ........... .. Vl/V ......Interior S!!efTIZdCK
y............................. ................
Heating :�9...........�.V...........G,4..S............................Plumbing .......I........ tS1.f.N......................:
Fireplace ....4Q.:.....................................................................Approximate Cost ............. . d�
Area ........ ................
Diagram of Lot and Building with Dimensions Fee .........6.1. ...............
oN -l�/t'sr�� s,A s )3 1014 '
3a x aY P ( �.
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .. 3
Construction Supervisor's 'License .....114.I.. 9. ...........
GREENBRIER CORP.
No Permit for ... ...Story.............
Y ...........
Single Family Dwelling.......
.............................................................
Location J?9t....#J.Q6.j......2...TARb.ar.k...R.o.ad
-Marstons Mills
. ...............................................................................
...Greenbrier Corp.wner ...G.............................
0 Type of Construction -.FX.4Me Ile.............................
... ........................................ ......................................
Plot ............................ Lot ................................
Permit Granted .....qaMAaKY...lj0.......19 89
Date,of Inspection ....................................19
Wit
DUte Comp'letqdd .... .................. ...19
>
P
49
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 0. -Parcel 0-57Z • Permit#
Health Division r F Date Issued
Conservation Division Fee � - 6W
Tax Collector l
Treasurer •._ s ,� .
PlanningtiDept.
Date Definitive Plan Approved by Planning Board r
Historic-OKH Preservation/Hyannis
Project Street Address t `�� �� �ZC�•
Village v-
Owner U��c�+�e (,c/�� e-- Address '�— -
Telephone `q
Permit Request V tm.y /C���2cP `'`-�`�' — n S-f.^vC�✓�
Square feet: 1 st floor: a isting proposed 2nd floor:existing proposed Total new
Estimated Project CosTZ1 - 0 Zoning District Flood Plain Groundwater Overlay
Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation.
Dwelling Type: Single Family 0// Two Family ❑ Multi-Family(#units) '
Age of Existing Structure Historic House: ❑Yes 3 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 Cl Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name 0— "A W A DA 49 Q S Telephone Number
Address `? Q0C�--w2_V License# 0 7c�1/S�j
AjaA Mk da,3u-i- Home Improvement Contractor# 1,7717
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 04
-7 S_ S Sew
SIGNATURE DATE
FOR OFFICIAL USE ONLY s
PERMIT NO. `
DATE ISSUED '
MAP/PARCEL NO. = t
ADDRESS ,� ,, . t VILLAGE _
OWNER ! ,
DATE OF INSPECTIO. a +
,
FOUNDATION
FRAME —. ~
INSULATION
FIREPLACE `
}
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL '
GAS: _ ROUGH FINAL _
FINAL BUILDING
DATE CLOSED OUT — -
ASSOCIATION PLAN NO.
The Commonwealth of Massachusetts
{�.� S --_ Department of Indust nal Accidents
- _- 011lce ol/�rest�gatioos
' -^ 600 Washington Street
Boston,Mass. 02111
Workers' Com ensation Insurance Affidavit
name:
location:
ity hone#
c❑ I omeowner performing all work myself
❑ I a sole etor and have no one in any
worlds on this ob
workers ensatlon for my g:.}:.:}:;;.:;� � ':,::::::::;:;{.;:{::}:;.}}::::<:>:::�>:«::<:;:::«:>::;�>:::>�::<:<�><::<>::
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❑ I am a sole proprietor,general ctmtrator,ar homeow°Q'( �
have
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insurance c :;:;.;}:. 0.:<;.:;.}:.
Failm�e to.,cure coverage as requiredceder acetion?5A oiMQ.1S2 can lead to the boon of erlmmal penalSe.of a Sae Up to S1,S00.00 tad/or
one yem,imprisonment as well as dva pmsim—in the form of a STOP WOGS ORDER and a Ste of$100.00 a day against me. I understand that a
copy of this statement may be forwarded to the OM=of Inver of Ste DIA for coverage verincatiam
I do hereby c under the pans and patalties ofperjz"&at the information provided above is true and correct
Date
+Sig ature
Print name�ud4, �, ,�� Phone i! Sag
official use only do not write in this area to be completed by city or town oIDcid
per=Mmcen.e fi ❑Building Department
city or town: ❑Idcrosmg Board
. ❑Selectmen's Otflnx
❑cheek if immediate response is require d (--]Health Department
contact person:
phone N, - ❑Other
Umsed 9/95 PJN
Information and Instructions .
all o to provide workers' compensation for their
Massachusetts General Laws chapter 152 section 25 requires employers
oted from the"law",an employee is defined as every person in the service of another under any contract
employees. As qu ...,_ .
of hire, express or implied, oral or written.
association, corporation An employer is defined as an individual,Partnership, or other legal entity, or any two or more of
msentatives of a deceased employer, or the receiver or
the foregoing engaged in a joint enterprise,and including the legal rep employees. However the owner of a
trustee of an individual,partnership,association or other legal entity, employing� Y ees house of
dwelling house having not mole than three apace therein,and who resides therein, or.the occupant of the dwelling
another who employs persons to do maintenance, canstcuction or repair work an such dwelling house or on the grounds or
building appurtenant thereto shall not because of such employment be deemed to be an employer.
state or local licensing agency shall withhold the issuance or renewal
MGL chapter 152 section 25 also states that every 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,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 iasivance
requircments of this chapter have been presented to the con:tractilug
authority.
Applicants
Please fill in the workers' compensation affidavit camPlctclY�by checking the box that applies to your situation numbers and
address and phone numb along with a certificate of insurance as all affidavits may be
supplyingcompany names,
submitted to the Department of Industrial Act for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be retuned to the city or town that the application for the permit or license is
b ' requested,not the Department of Industrial Accadmm Should you have any questions regarding the"law"or if you
lease call the Department at the number listed below.
are required to obtain a workers' comp�o�policy,please .
RVIR
City or Towns
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 has to contact you regarding the applicant. Please
be sure to fill in the peimii/lic nSe number which wilTbe used as a reference member. The affidavits maybe retamed io
the Department by mail or FAX unless other oft. have been made.
The Office of Investigations would I5ie.to thank you in advance for you cooperatim and should you have any questions.
please do not hesitate to give us a call.
immommmonom
FEMEM
The Department's address,telephone and fax m. =ber. _
The Commonwealth Of Massachusetts
Department of Industrial Accidents
0mce of Imsubatlons
600 Washington street
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 7274900 'eat. 406, 40.9 or 375
sae r,
The Town of Barnstable
KAMM Department of Health Safety and Environmental Services
� L659.��► Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: Pal t9.L P�M � WGt,_J 7 Estimated Cost p t
Address of Work:
Owner's Name:
Date.of Application: S 16 `0
I hereby certify that: .
Registration is not required for the following reason(s):
Work excluded by law
Job Under SI,000
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME E"ROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner.
Date Contractor Name Registration No.
OR
Date Owner's Name
q:forrtns:Affidav
I WQD0W8,-,e*tWGy /' PA*10•A00MS
OEPARINENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
Nueber: Expires:
Restricted To: IG
OYAYNE C ORAGGOO
SSII SPRING CORNER RO
�' f G�•....��S V7*A'/NIVBUgrp IN
•VINYL REPLACEMENT ,
WINOO`NS
.ice\ 4, !..ur.n.........
:i; pn.yc (HPEO'7E�E!li (nrliP,tr;'�
■ STORM DOORS 1L -
WINDOWS .+lc, r ., [roe - MIME rhuorFr,iil'r,
UinyF h)N la l v(nla i•a i?'� - !n'l
!I$r11AP`N
■ PArIO 4 ENr¢Y Doovs E,;p!!;,tli c (!r ail
• V'NIL S-M-Nr AND N3,M
• PArIO ROOM;u
PORCH ENCLOSURES
75 SrOCKWELL DR. ■ AVON, MA 02322
PH: 508-580-3119 • 877-946-3699 ■ FX: 508-580-6064
DA 04
::,K.:::......, T
IBILIY 'INQRANCE
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PRQ�S+ACER (513)421-6515 FAX (513)421-0130 THIS CERTIFICATE IS ISSUED AS A MATTER+OF INFORMATION
1999
alter P. Dolle Insurance Agency, Inc.
ONLY AND CONFERS NO RJGKrS UPON THE R XTE N
.THIS NOT DOES T AMEND
HO O OR
Suite �3200 312 Walnut Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Sui
Cincinnati , OH 45202 COMPANIES AFFORDING COVERAGE
Attn: Robert B. Barnett Ext: 214 coMAPANY Lumbermen s Underwri ti g n ..
............. ........................ . . . .
IN3URED
Champion Window Co. Of Boston South, LLC
• COMPANY
75 Stockwell Drive B
Unit #7 COMPANY
.................
Avon, MA 02322 C
....... ...... .. ..........
... .............................................
COMPANY
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IS IS TO CERTIFY THAT THE ....::................:....,..::..::::::._:::::.:::::.:�:•,;:::.;�;;;:•:>:; ; ` ::i:; E;i'z #?i>'::;<>>?
Pf�llCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED,NOTWITHSTANDING AW REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED ORAMY 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.
Co ................. ....
LTR TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
DATE(MWOC/YY) DATE(MMlOOr Y) LIMITS
GENERAL UABIUTY
GENERAL AGGREGATE f COMMERCIAL GENERAL LIABILITY .......................................................................................
` CLAIMS MACE PRODUCTS•COMPIOP AGO f
E OCCUR: i ... ... ...
PERSONAL 6 AOV INJURY f
OWNERS 8 CONTRAOTCR S PROT: .................................................................................
EACH OCCURRENCE f
i FIRE DAMAGE(Any one Afe) s
............................ .
AUToMcaLE LlAewrr AA EXP(Any on•peso.) s
ANY AUTO CCMBINEO SINCLE LIMIT f
ALL OWNED AUTOS
SCHECULED AUTOS BCOLY INJURY
(Pv person) '•
HIRED AUTOS
NG+L^wNEO AUKS BCOLY INJURY f
(Per D=Id nc)
..... ... ..................... .................... '
PRCPERTY OAMACE s
GARAGE LIABILITY
ANY AUTO
AUTO CNLY.EA ACCICENT f
• .. ... ... .. ..... ... ....
CT)-ER THAN ALITC ONLY
EACH ACCICENT f
. . ........................................ ......
EXCE33 LULBIUTY AGGREGATE f
UMBRELLA FORM ETCH 0CCURRENCE f
f
OTHER THAN UMBRELLA FORM AGGREGATE
WORKER!COMPENSATION ANDWC STA f
EMPLOYERS LIABIUTY X TORY LI Y M S ER
q :::.:..:.:..:....:
THE PROPRIETOR/ INCL 275086 12/O1/1999 12/O1/2000 EL EACH ACCICENT s 500,000
PARTNER&E XECUTIVE ..................................................... ..
OFFICERS ARE. EXCI' EL CISEASE•PCUCY LIMIT f 500,000
OTHER EL CISEASE•EA EMPLOYEE f 500,000
JE3CRIPTION OF 0pERATION3fLOCAT10N3lVEHIClE3/SPECUL REM!
SHOULD ANY OF THE ABOVE OE3CRIBEO POUCIE3 BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE IS3UIN0 COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE 3NALL IMPOS!NO OSUOATION OR LIABILITY
OF ANY REP�ILUNT�COMPANY R3 AOENT3 OR REPIIE3ENTA TO WHOM IT MAY CONCERN AUTHOROW
1�CtMC 2tI;:8(t%):...:...... ... ..,.
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CACORD CORPORATION JOBS
A.
._ CoRD :::CERTIFICATE;`':QF:.LlABILtTY:INSURANCE
: DATE(MMlpOlyy) ;
PRODUCER (513)421-6515 ,....,: :.... . ..:::: .:.::::...,:: ..:.... 12/06/1999
FAX (513)421-0130 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
alter P. DOl l e Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
312 Walnut Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
Suite 3200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Cincinnati, OH 45202 COMPANIES AFFORDING COVE RAGE
COMPANY Fi reman's Fund
Attn: Robert B. Barnett Ext: 214 A
.... ... .....
INSURED.
Champion Window Co. of Boston South, LLC COMPANY
75 Stockwell Drive B
Unit #7 COMPANY
Avon, MA 02322
COMPANY
D
THIS IS TO CERTIFY THAT THE L
POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED'A80VE FOR THE POLICY PERIOD
INDICATED,NOTWITHSTANDINC�NY REQUIREMENT,TERM OR CONOITION OF ANY CONTRACT T 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.
Co
TYPE Of INSURANCE LTR POLICY NUMBER POLICY EFFECTIVE:POLICY EXPIRATION
CATS(MMICOIYY) DATE(MWCC(YY) LIMITS
GENERAL LIABILITY
' GENERAL AGGREGATE S
COMMERCIAL GENERAL LIABILITY ........... ......................
,< : PRODUCTS•CCMPICP AGG S
CLAIMS MADE OCCUR
PERSCNAL✓<ACV INJURY =
CWNER'S 3 CCNTRACTCR'S PROT. ........... .... ............. . .......................................
EACH OCCURRENCE S
.. ...... ....................... FIRE DAMAGE(Any Gn•11ro) f
AUTOMOBILE LIABILITY MEO VP(Any on*person) S .
ANY AUTO CCMBINEO SINGLE LIMIT S
ALL CWNEO AUTOS
SCHECULEO AUTCS SCCILY IN URY $
(P�r Person)
HIRED AUTOS
NCN{WNEO AUTCS BCCILY:N.;URY S
(Pa+acu40,41
PQCPERTY CAMAGE S
GARAGE L1A81LIrY
i ANY AUTO ALA?O CNLY.EA ACCICENT $
CTI-ER THAN ALTO ONLY
EACH ACCICENT S
AGGREGAT= S
i EXCE31 WeILITY
I EACH OCCURRENCE A X UMBRELLA FORM $ 15,000,000
XYZ00096219456 12/01/1999 12/01/2000 AGGREGATE S 15,000,000
OTHER flaAN UMBRELLA FCRM
I S
� WORKERS COMPENSATION AND WC STA7,U.
I EMPLOYER3'LIABILITY TCRY LIMITS ER
TME PRCPRIETOR/ EL EACH ACCICENT $
PARTNERS/EXECUTIVE INCL
OFFICERS ARE, EXCL EL CISEASE•PCLICY LIMIT S
OTHER EL CISEASE•EA EMPLOYEE S
OE3CRIFTICN Of OPERATION3ILOCATIONyyEHICLE313PECIAL ITEMS
CERTIFICATE HOLDER:
:,. ...:..:...;.... ;;..:. CANCELLATION
SHOULD ANY OF THE ABOVE OE3CR18ED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE 133UING COMPANY WILL ENCEAVOR TO MAIL
30 0AY3 WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMP03E NO OBLIOATICN OR LIABILITY
OF ANY KINO UPON THE COMPANY,ITS AG T3 Cot REPRESS tVEs.
L�M
WHOM IT MAY CONCERN AUTHORIZED REPRESENTATIVE
C.
ACM (1M)
CACORD CORPORATION ISO
FACTORY DIRECT SINCE 1953
1 �
WINDOWS SIDING PATIO ROOMS
AFFIDAVIT
a VINYL REPLACEMENT I, the undersigned, being the owner of the property at
WINDOWS C� --a,nIWLi KW-Pn I hereby verify that I have
authorized Champion Window, Siding and Patio Rooms and
its agents to apply to the Building Department of the
City/Town of &,r5{ ?p 01,115 Massachusetts
siOV.L,r.)UDR to act as representative in obtaining building permit and, or
any zoning requirements-needed to obtain permits.
bllNDorv;
Signature of Owner U2LDate �a
a PAI10 Yjf N1RY 00 OP.
`: J
Address of property `j&kb, L,jz K>6
010 5, 01-4
O VINY1.SIDING AND 1RIPA
PAT 10 ROOMS&
PORCFI[NCLOSURLS
75 51*0CKVVE1-L DR. ■ Avow. MA 02322
PH: 508-580-3119 ■ 877-946-3699 ■ FX: 508-580-6064
Io , ; J.
Er y' , l.i-.. �- rcG IQ•S� i :C....,,1 Page 2/8
NiFRC Product Certification Authorization Report (U-Factor) .
Manufach"r Information IA Identifier: A
356, Champion Window Mfg.
11750 Commons Orlve Page. 1
Cincinnati.OH 45246
Product Information
SeneyModel: 800 DOUBLE HUNG
Product Type: Vertical Slider
NFRC Product 10: 356-A-006
Cert.Authorization Expiration Date: 11/17/2002
Delete Code:•
Laboratory Information
Simulation Report Issued By: SETC
Simulation Report Date: 10/2M8
Simulation Report Number: 03A-5719 0-510.0
Product information
Prod Del Ras NonRas Frame Sash Glazing Low'E'Data Film Spacer Gap
No U-Value U-Value Type Type layers Emissivity 1.2,3(Surface) (Surface) Gap Width Type Grid Fill
001 06 0.32 0.31 VF VF 2 0.03(3) 0.562 At a ARG
002 a,34 033 VF VF 2 0.15(3) 0 570 Ss S ARG
003 0:34 0.33 VF VF 2 0.15(3) 0 51 s St 9 ARG
a3aaellne Information
Test Thermal Tested Standard Thermal Test
Lao Test Date Test Sizes U-Value U-Value Report Numur
TETC 1111719d 36 x 80 34 .35 034-5741 0-510 0
TETC x
I hereby certify tat the above informatio s true to the best of my knowledge I also Certify that all requwraments for cer ificaticn
autholizaticn under the NFRC PCP haveipeen met. f , / t
Authorized IA Signature: J/�1�/cam. Date Approved: 11/17/98
Revised Date: 12/07/98
:u...-:a�
Ne RC Product Certification Authorization Report(U-Factor)
Manufacturer Information IA Identifier: A
368, Champion Window Mfg.
11750 Commons Drive Page. 1
Cincinnati,OH 45246
Product Information
Senes/Mcdel: 800 HORIZONTAL SLIDER
Product Type: Horizontal Slider
NFRC Product to: 358-A-005
Cert.Authorization Expiration Date: 11/1 V2002
Delete Code:
Laboratory Information
Simulation Report Issued By: SETC
Simulation Report Date 102"d
Simulation Report Number. 03-t-5720.0-510.0
Product Information
Prod Del Res NonRes Frame Sash Glazing Low'E'Data Film Spacer Gap
No U-Value U-Value Type Type Layers Emissivity 1.2.3(Surface) (Surface) Gap Width Type Grid Fill
Cot 06 0.33 0.31 VF VF 2 0.03(3) 0.5e2 Al 6 ARC
002 0.34 0.33 VF VF 2 0.15(3) 0.570 S4 B ARG
002 0.34 0.33 VF VF 2 0.15(3) 0 514 S-t 8 ARC;
Basellne Information
Test Thermal Tested Standard Thermal Test
Lab Test Date Test Sizes U-Value U-Value Repor Number
TETC 11/12/98 to x 36 31. 21 034-5742.0-510.0
TETC x
I hereby certify that the aoove informa6c is true to the best of m kno ledge I also certify that all requirements fcr certification
authorization under the NFRC PCP hav 'be-en met
Authorized IA Signature: Date Approved: 11/18/98
Revis.:d Dale- 12/07/58
cy: :n'?mp1Gn ,j ficC'J d.ir _ •= :Oj' e 4
j.' F2G iQ W' rjg /8
NFRC Product Certification Authorization Report(U-Factor)
Manufacturer Information IA Identifier. A
356, Champion Window Mfg.
11750 Commons Drive Page 1
Cincinnati,OH 452a6
Product Information
Series/Madel: 700 PICTURE
Product Type: Fixed
NFRC Product 10: 35d-A-004
Cart.Authorization Expiration Dote: 11/8/2002
De
lete Code:
Laboratory Information
Simulation Report Issued By: SETC
Simulation Report Date: 10/28l98
Simulation Report Number: 034-5710.0-510.0
Product Information
Prod Del Res NonRes Frame Sash Glaring Low'E'Data Film Spacer Gap
No U-Value U-Value Type Type Layers Emissivity 1.2.3(Surface) (Surface) Gap Width Type Grid Fill
001 0.32 032 VF 2 0.15(3) 0.570 34 8 ARG
002 0.32 031 VF 2 0.15(3) 0 514 yt 8 ARG
Baseline Information
Test Thermal Tesled StardarC Thermal Test
tat) Test Date Test Sizes U-Value U•Value Report Number
T=_TC 11/5/9e As 48 .29 29 034-5732.0.510.0
TETC x
I hereby certify that the above informatio is true to the best of my knowledge. I also certiFj that all requirements for certification
auttlortz3hon under(he NFRC PCP hal been met
Authorized IA Signature: . ^ Date Approved. 11/Ct3/98
Revised Date 12/CC-/n8
f •amp_Gr; .'r. :��:� roc• tU i I :U:ia;I
age 5/8
NFRC Product Certification Authorization Report (U-Factor)
Manufactumrinformation IAldenti}ler.- A
366, Champion Window Mfg.
11750 Commons Drive Page: 1
i Cincinnati,OH 45246
Product Information
Series/hlodel: 700 AWNING
Product Type: Projected
NFRC Product ID: 356-A-003
Cart.Authorization Expiration Date: 9/18/2002
Delete Code:
Laboratory Information
Simulation Reacrt Issued By: SETC
Simulation Report Date: 10/2V98
Simulation Report Number 034-5709.0-510.0
Product Informatlon
Prod Del Res NonRes Frame Sash Glazing Low'E'Data Film Spacer Gap
No U-Value U-Value Type Type Layers Emlaslvity 1,2,3(Surface) (SurfaGe) Cap Width Type Grid Fill
001 0.32 032 VF VF 2 0.13(3) 0 570 S'4 8 ARG
002 0.32 032 VF VF 2 0.15(3) 0 514 S4 8 ARG
Baseline Information
Test Thermal Tested Standard Thermal Tex
Lab Test Date Test Sizes U-Value U-Value Report Number
x
x
I hereby Certify that the above intcrmadon true to the best of my kncwledge. I also Certify that all requirements for certification
authcnzahon unCer the NFRC PCP have en met. �L'
L
Authorized IA Signature: Gate Approved 09118"98
Revised Date. 1210698
C
NFRC Product Certification Authorization Report (U-Factor)
Manufacturer Information
366; Cnampion Window Mfg. la Identifier: A
11750 Commons Drive
Cincinnati.OH 4524E Page: 1
Product Information
'Sarlee/Mcdel: 700 CASEMENT
Product Type: Casement
NFRC Product IQ 356-A-002
Can.Authorization Expiration Date: 9/18/2002
Delete Code:
Laboratory Information
Simulation Report Issued 13y: SETC
Simulation Report Data: 1028/98
Simulaacri Report Numter: 034-5709.0-5t0.0
Product Information
Prod Del Reo NcnRes Frame Sash Glazing Low'E'Data
Film Spacer Gap
No U-Value U-Value Type Type layers Emisslvity'1.2,3(Surface)
(Surface) Gap Width Type Grid Fill
001 0.22 0.32 VF VF 2 0.15(3) 0.570 S4 B ARC
002 0.32 0.32 VF VF 2 0.15(3) -
0514 Ss t? ARG
Baseline Information
Test Thermal Tested Standard Thermal rest
Lab Test Date Test Sizes U-Value U-Value Report Numcer
TETC 9/18198 30 x 60 r4 TETC x .34 03-t-5731.0 510.G..
I hereby certify that the above Information s true to the best of my knowledge. 13130 certify that all requirements for certincation
authorization under the NFRC PCP have een met.
Authorized IA Signature:
Date Approved- 09/16r98
Revised Date' 121061<98
I / �r;d;np 1�i; ... .. _ �i:, .. �C .7ru ice -__ i _ .;a�� rage 7 8
HFRC Product Certification Authorization Report (U-Factor),
Manufacturer Information IA Identifier: A
356, Champion Window Mfg. .
11750 Commons Drive Page- 1
Cincinnati.OH 45246
j Product Information
Seriewuodel: 3100 PATIO DOOR
Product Type: SW111g Glass Nor
NFRC Product Io: 356-A-001
Cert.Authorization Expiration Date: 10/5/2002
Oelete Code:
Laboratory Information'
Simulation Report Issued ey: SETC
Simulation Report Date: 10/28/98
Simulation Report Number: 034-5718.0-510.0
Product Information
Prod Del R--s NcnRe9 Frame Sash Glazing Lcw'E'Oab Film Spacer.. Gap
No U-Value U-Value Type Type Layers . Emusivir/1,2,3(Surface) (Surface) Gap width Type Grid Fill
001 0.35 0.35 VP VA 2 0.15(3) 0.750 S4 8 ARG
Baseline Information
Test Thermal Tested Starcard Thermal Test
Lao Test Date Test S¢as U-Value U-Value ReNrt Number
TETC tc/5/98 71 x 79 .40 .39 024-5740.0-510.0
TETC ,
I hereby cenity that the above Infcrmatl n is true to to best of my knowledge. I alsc certify that all requ,ryment3 fcr certification
authorization under the NFRC PCP ha a be-en met
Authorized IA Signature: Date Approved 10/05/98
Revised Date 12/OF/98
=i namp fun ,7_i;,;-.%
National Fenestration Rating Council,Inc. -Certlfled Product's Directory Page: W1
Product Description Glazing Description 'Energy Ratings'
Individ. Manufacturer Number of Glazing layers;Spacer Type; Gap U-Facor U-Factor
Product Product Code Low'E'(Emissivity 1.2,3)(Surface):IF-Internal Film(Emirs)(Surf.); Wldth(s) RES NON-RES
Number Primary Insulating Glass Gap Fill and Grids(T,Y,or B); (Air Spaco 1.2-3) Siza Size
Manufacturer. Champion Window Mfg. Manuf. 10: 356. CHW IA: A
Product Line: 356-A-001 Product Typo: Sliding Glass Ooor Frame Type: VP
3100 PATIO DOOR
001 2 S4 0.15(3) ARG (6) 0.750 0.35 0.35
Manufacturer: Champion Window Mtg, U3nuf.10: 3S6, CHW IA: A
Product Line: 356-A-002 Product Type: Casement Frame Type: VF
700 CASEMENT
001 2 S4 0.15(3) ARG (8) 0.570 0.22 0.32
002 2 S; 0.15(3) ARG (8) 0.514 0.32 0.32
Manufacturer. Champion Window Mfg. Manuf. 10: 368, CHl! IA: A
Product Line: 358-A-003 Product Type: Projected Frame Type: VF
700 AWNING
001 2 S4 0.15(3) ARG (8) 0 570 0 32 0 32
CC2 2 S4 0 15(3) ARG (8j 0 514 0 32 0 32
Manufacturer: Champion Windcw Mfg. Manuf. 10: 35.i. CH'+V IA: A
Product Lira: 356-A-OC4 Product Type: Fixed Frame Type: VF
700 PICTURE
CO1 2 S4 0.15(3) ARG (B) 0.570 0 32 0.32
CC2 2 Ss 0.15(3) ARG (8) 0.514 C 32 0.31
Manufacturer: Champion Wlr.cco Mfg. Manuf. 10: 258. CHW LA: A
Product Line: 356-A-005 Product Typo: Horizontal Slicer Frame Typo: VF
800 HORIZONTAL SLIDER
CO2 2 Ss 0.15(3) ARG (6) 0 570 0.34 0.33
003 2 S4 0.15 (3) ARG (8) 0 51A 0.34 0.33
Manufacturer. Champion Window Mfg. Manuf.10: 366, CHV'/ IA: A
Product Line: 258-A-006 Product Type: Vertical Slider Framo Type: VF
800 DOUBLE HUNG
CO2 2 S4 0.15(3) ARG (8) 0.570 0 2A 0.33
CO3 2 S4 0 15(3) ARG (8) 0 514 0 7A 033