Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0026 WEATHERVANE WAY
����� ,, r 3M!, i-r ..L1�i6.es.., .., n i e b m °FW,�r. 'Town of Barnstable *Permit# �• 't• Expires 6 ondrs from ice date Regulatory Services Fee > 13AIlIMMIZ � v MAM Richard V.Scali, 1639. �0 Building Division NOV 01 2011 Tom Perry,CBO,Building Commissioner `f B y io 1`tr"0 6i�K�l b I�17 � 00 Main Street,H ant ,t 6 � www.town.batmstable.ma.us Office: 508-862 41038 Fax: 508-790-6230 EXPRESS PERMIT.kPPOCATION - RESIDENTT AL ONLY Not 4'ulid ivithout Red X--Press Imprint Map/parcel Number 7 - DY k Property Address (o �A ✓ '-),AV14� / 2"Residential Value of Work /S Z ff S� Minimum fee of$35.00 for work under$6000.00 Owner's Name S!-address q Ua, DeMerI ta el t lew(-Aer✓ ars4 5 Hi Contractor's Name W 00 O)OA ./GFF rF.F_LF_ Telephone Number 7ff Y�� Or- 3VC-1D&-) Home Improvement Contractor License'#(if applicable) 1&6 OZ�6' Email: Construction$itpervisor's Licensc n(if applicable) YVorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [� I have Worker's Compensation Insurance Insurance Company Name �fA?,� 1h R;1: 1uS i2 �.Eo�-A (Yt 0 / Workman's Comp.Policy# 22 W f�-C`--T 2_6 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side - R"Replacemen[Windows/doors/sliders.U-Value •2-1 (maximum.32)#-of windows it 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 equired. SIGNATURE: - C:\Users\Decol i atat c.1%,icrosu t tnduws\Temporary Intcmet Fi1cs\Content.0udookLP101 DFIR\EXPRESS.doc Revised 04021= i a:. TelviA polc.el d-N LPr Z- °Window World of Boston,LLC MA HIC Registra&on Offices&Showrooms Number. 015A Cummings Park 0 295 Ord Oak Street 166026 ftburn MA 01801 Pendnoke,MAOM59 Federal ID# pal)932-4805 (781)82&8281 27-1481665 "Simply the Best for Less. YAAI.WindovANoddolBoston.com customer. fF Q-- Ins1aU Address`,26 Phone(w) aty-jm& '� MY-Z S State:W1Zipa&!Vg Email WINDOW WORLD GLASS OPTIONS _1000 Series Single-hung A11AWd "$169 -j_SclarZone Elite $119 2000 Series DH Mects/weided Sash $216 _Triple Glazed TW $195 Z 4000 Soles DH AII-weld .3225]3 CScdas 6000 011W `6000 Sedas DH AU-weld 3260L WINDOW OPTIONS _2 Litt Slider $354 Glass Breairage Warranty $15�YCt DEU Q 3 Litt Slider I A v%,m prc to va $545 1/2 Screens S9I:%RE TPicture/FhredLUe $354� #4/—FoarnInsulationonJambsandHoed $11INCLUDED _Av+nin9 $ZFp Double Strength Glass S1S IdCLU0ED _Casement $310 _Double Locks(>26) $5 UICL M _2 Life Casement $Ssg _Full Screens $22 _3 Ute Casement pa.w.vn 114L r $SBD _Colonial Grub(Contoured/Flat) $45 Preiria Grlds $51 _Basement Hopper c834 ^DiamarrtdGrids `� _Bay Window-Soffit Mount/INS Seat$3660 Simulated Divided Lite $OS Bow Mndow-Soffit Mount I INS Seat$278B Simulated DH Sash i eS0)(rS0) $82 G82 arden inchlmu $2040 —Obscure Glass(080)(TSO) S35 SAeCiaRy Windm�r 5 _Oriel Style(40/60 or 60140) $30 _Beige/Almond $40 _Foam Enhanced Frame $35 _t4aad Main Interior(Series 4adelGdPOonly)$100 PRE 1978 BUILT HOMES(EPA LEAD SAFE REND N) (U2V Cak1 Dark Caa!Chary/Far stnwel mete rN ) _Load Safe PredfCas Required MY HOME WAS BUILT IN THEYEAR_QQQ ' _B---3sfeslarordL&orv�/Arrr ticanTers�3t00 MISCELLANEOUS Dwwar Color aeriar 5176 Custom Evattor Aluminum Cladding HAndaw Color J O Textured$75 ooth M/00 $}300 Inr:de omlbe Facing Color MON CUSTOM ODORS —Metal SYndow Removal $50 _wlanytttogingP�t0000r 5fLor6tt $rays NewCwstrrmdanVinylRernmial ^s175 wrortRollingPacoMar OIL Sti95 ^Spocialb/Window EdariorVim 3 pddrob—Wlcsfai itof,gPaao0or31930 Mull to Form MtdgUnit $3D—� _tench Rail Sradatq Patio Door 9tL or at $i395 Install trlerlor/E derlor Stops $60,3202 French Rail Siding Patio Door OIL $1495 _Install interior Casing Starts At$95 _Rendr Rail Sli tq Pato Daor 91 $11595 Insulate wdot Boxes $20 CrutLm Etdertor Cla id'utg S140 _Roof for Bay/Bow windows $SM 1 9oferZons Elite of ETC Gress S205 EAsting New Cont.ExL Retro Rt $160 <irids Pafs Darr 5149 I Removal of adsting Bay/Bow S28a _Y/aodgrein Intmims ins _Repair SM.Jamb or replaco Bill nosing $60 ' E)dartor DesignerCotora $395 _Full Sub-Sill(Single)rep(aCMMnt $150 �mm�mCasing 2ur 3va $t)3 Niullion Removal $30 _rsandlesetoptions S TI3ayffl.Co !w ionEb&RM.Fit $BW= (Now Siding wIU Not Match) Door Cola - --- •_........__ _____.^.�. —....---_....�ONdMe--- 4`�`!r„'r"1! Customer dednes ertter)orvnap and understands painting and/or repair may, tnfUai Customer declines grids on lvindows/doam I 9lSl�,y�LlrsWmairrcstor@etcLb�gcrcarnrcYonvhhNsconhndPais9:g,Sti>rrg,AFimSysfaa?aemnah4eoomxrdtalBrpParaateaia _ ��� escess of E2S60.Horown(end or Cards kssocla t kpptrfA Kitada District tweaal.Cry of Baden patina&tt fe Zh anafaFop NO EXTRA WORK fF NOT IN WRITINGI Customer agrees to the terms of payment as follows: `� c Extra Labor&.Materials $ 2 Site Sol Up,Pdrmit,Disposal&Delivery Foes$ $389.0D Total Amount $ `,� Custom Order Deposit 60% Smqmf(f Balance Paid to Installer upon Completion $ Amount Financed $ ft.dawylorldat Boston Wkipmstuft Rsrrofcar ardbd�subsmnhtyeampteDedinI Arrs.SaeofiyirpiestYes No Rol O posit tetehed'n aft=of the stare of thtwM�33'0%ol Um mtai contrast wito ort m�aaxual cast al aay mUrdal or ePsivtasni a spa41 order at comm made reface,wft mutt be ordatd In adrune of ft3brt4rgmvim%lo a33Mdrat08 dro)ettwD proceed m tcheoift t1a bd tratrays tali be demarded era Un emLad to comidittd Oaths sillslatrw of bO p0es. ill home boomtemnd exmbactors sad sA arm¢mrs sb3!1 he regislued mad that any iAVN obod a car nd er wbwntm*f 91Mtg ro a reg stralan shmtd be 4rttledto Office ofConsmnarAflaha sad BuatausRsgdaUon,Tm Pak RaM$av$1709ostaa,MA02116.Ploo:(617)973-ano No amil sball begio prior to Ito tiplag aloe elatraat ead MaaMilal to Ilia awns of a copy alsoch torttreet Y:ndew'Radd of Boston uader proutsbo of Chapter 142A d the gmeW Urns is fv%4W to 1pp'y for and obte!e a'1 consrattioMrrlaled peons.VIAdmv 11AM of Boston SM set be doomed responsatetmdohyz!nUA*dasaiSedinftayumad caused EyMp,'argPerna6larfagaMie%aallodOofIlldNduais Roger It Ike PURd1ASERp)obtain b1toneonstmcNoo retold eartdbtoIketwiltdescriedorderhhedreamentardaalsrotaamethterademtraatats t►a PURCMER(5)it hereby smelted Piet id rhs tram at a dlel oft,WIlemeet aed mapaymtrd,the PURCIRMER(S)will ad be eaM to mte a dahh Of cdier0ao from Itre pu"[mid ectahllsbgd by d apter 142A,ALL. Massachusetts Department of Public Safety ® Board of Building Regulations and Standards License: CS-072772 Construction Supervisor JEFF C STEELE 24 SHERWOOD AVE s .- DANVERS MA 01923 Expiration: Commissioner 04/07/2018 Office of Consumer Affairs&Business Regulation --j'HOME IMPROVEMENT CONTRACTOR s Registration: 166025 Type: Expiration: 4112/2018 LLC WINDOW WORLD OF BOSTON,LLC. JEFF STEELE 24 COMMINGS PARK SUITE 15-A WOBURN,MA 01801 Undersecretary License or regIstration valid for individual use only before the expiration date. If found return to:Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 j ,lot valid without signature The Commonwealth of Massachusetts kiDepartment of IndustrialAccidents I Congress Stree4 Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERM TING AUTHORITY. Applicant Information / /' Please Print Legibly Name (Business/Organization/Indi�idual): (�%lda�/ WD/�Q t S�6 Address: 15-A C n,�•-.: s K City/State/Zip: tt�r7 A OW I Phone#: -781 -9 3 Z - qk o s Are you an employer?Cbeck the appropriate box: Type of project(required): 1.[I am a employer with-.TQ employees(full and/or part-time).' 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required] 9. El Demolition 3Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employes and have workers'comp.insuranre.i 14.Fe0ther WtndoL..) 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have ne employees.[No workers'comp.insurance regWred.j Tf rR ne/," •Any applignt that checks box M must also fill otuthe section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then him 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'camp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: 14 a.!-ItG-rg F m Tn 5 J RA 9C f- C—ep . Policy#or Self-ins.Lic.#: Z /Z W/F- C L ,).2 Ia Expiration Date: 1- 2- 7- 19 �/ Job Site Address: 2 C, Weaer✓QR� �/�Y City/State/Zip: S f s r 7� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration te). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this ement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifi 'otL 1 do hereby cer under 'p erjury that the information provided above is true and correct Si aiure: Date: ! Phone#: - .3 Z-- �S use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Toam Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Ot:her Contact Person: Phone#: f ��..., WINDO-2 OP ID:HI ACipRD CERTIFICATE OF LIABILITY INSURANCE DAM o505( 104120a2o17 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 policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and.conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). —il PRODUCER UZ.cT Carli Witcher CISR,CBIA,CIC Marsh 8,McLennan Agency-GSO PHONN , 336-272-7161 1 FA c Nk 336.346-1397 3625 N.Elm St Greensboro,NC 27455 ass:Carli.Wrtcher@!marshmma.com C.Timothy Ward,CPCU,CIC INSURERS AFFORDING COVERAGE NAICE INSURER A:Hanover Massachusetts Bay 22306 INSURED Window World of Boston,LLC INSURER B:Allmerica Financial Benefit 118 Shaver Street INSURERc:Hartford Fire Insurance Co. 19682 North Wilkesboro,NC 28659 INSURER D: INSURER E: INSURER F: COVERAGES CERT¢ICATE 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. I"SR' AI)DUSUBRi POLICY EFF POLICY EXP LIMB LTR TYPE OF INSURANCE I INSD'WVD. POLICY NUMBER D MNUDDIYYYY A : X COMMERCIAL GENERAL LIABILRY EACH OCCURRENCE 'S 1,000,00D1 I CLAIMS-MADE ' X *OCCUR IDDS7902527708 04101/2017 04/01/2018 PREMIX ocao,Q„Q, s 500.0001 MED EXP(Am•one person) PERSONAL E ADV INJURY 1,000,00D •GEN*L AGGREGATE LIMIT APPLIES 13ER: GENERAL AGGREGATE S 2,1300,00 _POLICY j� LOC PRODUCTS-COMPIOPAGG S 2,000,00 OTHER: S AUTOMOBILE LIABILITY :(E2COMBINEDaLIABILITYSINGLE LAWIT s 1,000,000� iB X ANY AUTe AW68757615 06/16/2016 06/16/2017 BODILY INJURY(Per person) = I ALL OWNED SCHEDULED BODILY INJURY(Per accioent) S AUTOS Avros NON-OWNEL PRO?- .DANWGE 5 HIREDAUTCS AUTOS (Peraccrdenti X _UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 2,000,000� A EXCESS IJAS CLAIMS•tAADE: ADS79025270B 04/01/2017 04/01/2018 AGGREGATE S DED RETENnONS S :WORKERS COMPENSATION X �ATIJTE ERA _ 1 'AND EMPLOYERS'LIABILftY Y 1 N C •ANY PROPRIETORIPARTNERIEXECLITIVE I N/A �2WECLJ2635 01/27/2017 01/27/2018;E.L EACH ACCIDENT s 500+00 OFFICERIMEMBER EXCLUDED? �: NODODD. (Mandatory In NH) E.L. L.DISEASE-EA EMPLOYEE 5 ; If yes,describe under E.L.DISEASE-POLICY LIMIT .5 500,000 DESCRIPTION OF OPERATIONS below DESCRIP'nON OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddBlonel Remarks Schedule,maybe attached lT more space Is requlmd) - 1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL I En BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable *Permit# OExpires 6 months from issue date Regulatory Services Fee 3!S; aAMSTAet.E. = v� MASS. g Richard V.Scali,Director Building Division ® M0 4 Tom Perry,CBO,Building Commissioner �� 2 3 ��q� 200 Main Street,Hyannis,MA 02601 A I www.town.bamstable.ma.us `-(ABLE TO N 230Office: 508-8624038 F ;� 0 �EXPRESS PERIMIT APPLICATION - RESIDENTIAL ONLY c Not Valid tvithout Red X-Press Imprint Map/parcel Number /y'� 'I Property Address-,� t,l gAer✓anf- f.1y �4/,40,1 S t�$ [Residential Value of Work$ 2_� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ff cksed 1-0e neri t a✓1 ft l ea A eI'✓ ►fl e— at r S�Dl S �r'� S Oo1 Contractor's Name W I7tJ Number 7 91 of 3asUA Home Improvement Contractor License#(if applicable) /66 OZ,T' Email: Construction Supervisor's License#(if applicable) 87 2-:7_2-- - Yvorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name i4mirp9L IIZz-- �IUsltl� C M Q�7C� Workman's Comp. Policy# aZ W F—CL.T 26 3S Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side [Replacement Windows/doors/sliders.U-Value - 3 D (maximum.32)#of windows ? #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical& Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department re ulations,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 equired. SIGNATURE: C:\Users\Deco)i ta\ cal\Micros mdows\Temporary Internet Files\Cbntent.OutlookLPIOI DHR\EXPRESS.doc Revised 040215 °Window Worid of Boston,LLC MA HIC Registration Ai Offices&Showrooms Number: / A Cl 15A Cummings Park O BS O,d Oak Streat 166025 Woburn,MA 01801 Pembroke,MA OM59 Federal ID B "Simply the Best for Less° (781)932.4805 (781)82i3.6281 27-1481665 i :v1wj.WindowWoddofBoston.com Customer: /f%`l�if 2D /77A� Phono Install Address:Z // T Phone City:/�7/Qi� iKjr /J7/[L�c State:MA Lp DI��R Email WINDOW WORLD GLASS OPTIONS _1000 SedesSingle-hungAll•Weld $189 —&_SolarZaneEliite $119 95'z. woo Series DH MechAVelded Sash -S215 _Triple GlazedTG2• Sim a4000 Series OH All-Weld $225ZW I Seiim 6000Cng) _60D0 Series OH AD Weld $260 WINDOW OPTIONS _2 Lite Slider $594 ✓/Glass Breakage Warranty S15, LUDED _3 Lite SlkWr nra.to vn PA t2 vo S545 t/2 Stxeens $grit _ MUDI Picture I Fated Lite S354 Foam Insulation an Jambs and Head S11 INCLUDED _Awning $280 Double Strength Glass S15 INCLUDE _Casement $37p _Double Lacks:(>261 SS IYCLUDED 2 Lila Casement $595 _Full Screens 522 _3 Lite Casement pp.+Atm VA,,A,>n $880 _Colonial Grids(Contoured/Rat) S45 _Basement Hopper $y�q _._fie GildsS51 � _Bay Windav-Soffit Mount/INS Seat S2660 —Olarsrond Grids $69 _BowWmtlarf-Soffd Mount/INS$eatS2785 --Simulated Divided Lite $182 Garden Window _Tempered DH Sash(BSO)(TSOj $65 S2040 _Obscure Glass(BSO)(TSO) $35 _BeigSpee Almty ndovr $ _Orial Style(40160or60/40) $30 Beige/Almond $40 `_foam Enhanced Frame S35 _'Nood Grain interior Was $Veil pqE 1978 BUILT HOMES p.tghl Oak/Dark Oak/I Cherry/Far Wood (EPA LEAD SAFERENOVAT/ON) Rch,uapie) _Lead Safe Practices Required $30 _MGM Ederat(prdL Bronze/AmeicanTerra)$t00 MY HOME WAS BUILT IN THE YEAR_Zf!a frd MISCELLANEOUSlia D�ignerCciorExterior $175 ��;.� Custom Exterior Aluminum Cladding Window Cofer ` ! /, O Textured$75 ❑Smooth$75 S rnarde OWStde Fatting Color NON CUSTOM DOORS —Metal Wriclo Removal $50 Vrryl Rabkrg Patio Coat 51 or 61L S1 os5 Nerr Construction Vinyl Removal $175 _ 'Arryl Rolling Patio Deal SIL $1195 _Specialty Window Extatlor Trim $ AddtobasapteeforCwlcmRaLingNUO0oarS1250 _Mug to Form Multi Unit 530 _French Rail Siding Pago Door Sn.or 6R. $1395 _Install Imedor/6dertor Stops $50 _French Rall Siding Pall Dwrrift $1495 _Install Interior Casing Starts At $95 _French Rail Sliding Patio Door 9H. S1595 Insulate Weight Boxes $20 Exterior Cladding 3150 _Real for Bay/Bow Wndows $50D _SolarZons Ella or ETC Glass 9205 _114sting New Cling.Ext.Ratio Ft Si 50 _Grids Patio Door $149 Removal of Existing Bay/Bow $250 _6tbodgrain Interiors $295 —Re Sill,Jamb or replace_E terior Designer Colors $395 p place sill nosing $50 Inferior Casing 2n 3111 3175 — an Full Sub-Sill(Single)replacement $150 / O HandlesetOpttans S _Mullion Removal $36 $ Bay/Bow Conversion Exl Retro Ft S350 (Now Siding W71 Not Match) Door Color rnsrde ) ovsfde Upq91AWRILb,LA11BS _ ,dcic�.bl f (➢Idi' tl 113i 'Tv'' �:�`' Customer dedinesexlerior Wrap and understands pa ting arid/or repair may 0 q 'Wad initial m. Customer declines rids On ALF windows/doors Inniai DISCLAIMER:Wstarrrs resporutde far thaWlWA9 in comedian with this conlrast gnGng swel men Spero ersmmectweanect&iift➢cg Permit fens in excess of$25.00,Homaaknar and er Cowin AssordaVonAppmvA,1➢dode DBMct 1ppreral cly of Boston pa,1S1g L C,rtnak Permttfeu in mmhee0m Vim hstah2a4 NO EXTRA V/ORK IF NOT IN%VRITINGI Customer agrees to the terms of payment as follows: Extra labor&Materials S 9V -� Site Set Up,Permit,Disposal&Oebpry Fees$ $389.00 TofalAmount S 2 Custom Order Deposit 5D% $ Ck# Balance Paid to Installer upon Completion $ Amount Financed $ wirdoyr Viale d Boston dl'dpams sfartfag tots uork on -[�j aid ba rig substanlsN wrt4l:tad In da➢s.Seedy weresl•yes Cb Any d�aat nm6ted 0 advance of the sYan d the emrk s L Na exreed 331/3S al tee total coronets pike Of aeWal mSl al any mrhahterfal err equiprttenlTa spedelatd�orarstahimadenature,whichoresbeorderedinadvantceoffhestartalP.e welkin assmo bafetaprajecttr8proceedmschecrletroPohlpayma¢ t a bademandedtad3>feconhaetiscmrpkte0totlrasa tlonalbothpanes. beregfsteredandeat any inquhes 90111 a COOKI err sdbcdfdraablr relating to a recistralim skald be ted tel Obiee at Cao�rticr AHalrc Bad arnl lea Rettlatta,Ten Padt Plana,So"S170 Boston,MA 02116,Phone.,(617)973J1700 elraan�1111 to Me carrier of a ropy of sorb cormact, ot 1Vedd of Boston trbrt praviaion d chaPty 14yA d the gairand lass is required to appy for and obtain all consbuctm-rdailm pemWs yrndow world d Notion shall not be denied fesponsPo s for delays N ins Walt described in this agreement caused by rapftloM pwd lraryn➢agencks,au h lbes a,(acvidlyes. Ne9ee:U lAa P1>ftCtIASER(S)aa�ias bis ovm emelntel ao is'led permill for themorkdaaaUee cutler this IlRement or do*wilb unregistered Contractors, Ra PURCHASER(S)Is hereby advisee Thal to IN ever at a dispate,lad➢emeat and ruapaymu%The PUBtJ 3ggS)will nil be colon fa mate a claim of heat Ina Guaranty fond eslablWad by chapter 142A,N.G.I ou Ule trip may cancel this Irassastigo at airy LIM p or to m ght of the third aSiptte4 y a er a date of this transaction. Notice W sanoellalldn titsl be is wriDng postmarked no later than nildmighl of the fallowing Dorf business day. This vtrdavvWNtd=rrarchsepie u asradmd rn'edh C rid Nauo tutanunsetmmVthdos4 ne .01 8 xncr.Qo net ern n shoo era y blank aparbe. Data --i5aiosm O mini ei ern are any blank apa a .W.aer:Do not slgn B them are any Weak spaces. Own aot.ml? Whim Capfr-OdgL�sl Yellow Ca _.. PY•io Ptnit CApy-CusIDmo wru vrw.�eavac.tt,e i ti Massachusetts Department of Public Safety ® Board of Building Regulations and Standards License: CS-072772 Construction Supervisor JEFF C STEELE _ 24 SHERWOOD AVE - DANVERS MA 01923 Expiration: Commissioner 04/07/2018 f Office of Consumer Affairs&Business Regulation —'xHOME IMPROVEMENT CONTRACTOR Registration: 166025 Type: Expiration: A/12/2018 LLC WINDOW WORLD OF BOSTON,:LLC. JEFF STEELE 24 CUMMINGS PARK.SUITE 15-A WOBURN,MA 01801 Undersecretary License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Az A4ot valid without signature The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114--2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual): ,A j,-AL,/ 41,o rld 2:e f L` C Address: /5'H C n„�.,v► s R, K City/State/Zip: i0q n M A e)leo I Phone#: -78 I -9 3 z - qg o S- Are you an employer?Check the appropriate box: Type of project(required): l.[g'l am a employer with_TQ employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for 7in8. Remodeling any capacity.[No workers'comp.insurance required.] 3.Fj I am a homeowner do' all work myself 9. ❑Demolition mg ys [No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that aU contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.QPlumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.aR0of repairs These sub-contractors have employees and have workers'comp.insurance.= / 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14 Others n�p k„) 152,§1(4),and we have no employees.[No workers'comp.insurance required.] f'.Q e I dI re,-17 --rs Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy andjob site information.Insurance Company Name:_ Pa -t-Cp-rg TnsJi t99Cf. C© Policy#or Self-ins.Lic.#: Z 2r W l= C (_ ,j � Expiration Date: /- Z 7— /R i Job Site Address: v2, � L/f�r�ier(,& 1e 14/4 5/ City/State/Zip: InArs-loa s H;ils M14 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 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.A copy of this ement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifi 'on. I do hereby cer under a pai erjury that the information provided above is true and correct. Signature: Date: / Phone#: - 3 Z.- 05 a use only. Do not write in this area,to be completed by city or town of wiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: i WINDO-2 OP ID: HI A�ORD CERTIFICATE OF LIABILITY INSURANCE FDATE 05104/2017l7 05/0412017 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 policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Marsh 8 McLennan Agency-GSO PNAME: CHONE . arli Witcher CISR,CBIA,CIC Fax 3925 N.Elm St AIc No.Ext:336-272-7161 A/c.No 336-346-1397 Greensboro,NC 27455 EE-MAIL Carli.Witcher@marshmma.com C.Timothy Ward,CPCU,CIC INSURERS AFFORDING COVERAGE NAIC S INSURER A:Hanover Massachusetts Bay 22306 INSURED Window World of Boston,LLC INSURER B:Allmerica Financial Benefit 118 Shaver Street IN SURER C:Hartford Fire Insurance Co. 19682 North Wilkesboro, NC 28659 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. I TR I TYPE OF INSURANCE i D �SU M pD � t MPOLICY EXP MUDDIYYYY I LIMITS L SI i I INSD NIVD i POLICY NUMBER A I X COMMERCIAL GENERAL LIABILITY I 1 EACH OCCURRENCE is 1,000,00 I OCCUR X i ODS790252708 04/01/2017,04/01/2018 DAMAG RE CLAIMS-MADE I I PREMISES Ea occurtence S 500,000 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY 5 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: i I GENERAL AGGREGATE S 2,000,000 POLICY JEa LOC i 1 PRODUCTS-COMP/OPAGG S 2,000,00 OTHER' i ;s i AUTOMOBILE LIABILITY I I COMBINED SINGLE LIMIT i Ea accident) S 1,000,000 B 1 X i ANY AUTO I ':AW68757615 06/16/2016 06/16/2017 i BODILY INJURY(Per person) 'S i ALL_AUTOS OWNED _AUTOS - ! i BODILY INJURY(Per accident);S NON-OWNED i ' PROPERTY DAMAGE HIRED AUTOS AUTOS ! Per accident :S 1 X UMBRELLA LIAB' X .00CUR I I 1 EACH OCCURRENCE S 2,000,000 A i ;EXCESS LIAB ICLAIMS-MADE; OD6790252708 04/01/2017 1 04/01/2018;AGGREGATE S DED I i RETENTION S 'S �VJORKERSCOMPENSATION I j X PER i OTH- , AND EMPLOYERS'LIABILITY YIN I - STATUTE - i ER C :ANY PROPRIETOR/PARTNER/EXECUTIVE I �22WECLJ2635 01127/2017 1 01/27/2018 1 E.L.EACH ACCIDENT % I OFFICER/MEMBER EXCLUDED? ❑I NIA, S 500,00 (Mandatory In NH) i E.L.DISEASE-EA EMPLOYEE'S 500,000 If yes,describe under ' DESCRIPTION OF OPERATIONS below ! j E.L.DISEASE-POLICY LIMIT S 500,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached ff more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 419 ' Parcel Application # g — �6 Q Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee �s Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address ca (o tn Ar-rS-ibN i S Village ��//�� Owner R iG1tiA-r9 y)=Moo_ r ',A4 j Address 01 (. Telephone bjb�- )\-4 Lo Permit Request CD fir" S-A-l�n.r, �3� �NS�I��e L .� 1NSc�(,l �oA-/o 'i Ns Ac�J. 4,�, ( Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatiot a 1 912,71 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout 0 Other Basement Finished Area (sq.ft.) Basement Unfinis d'/A?A1(s a r Number of Baths: Full: existing new Half: exis�A 7 new Number of Bedrooms: existing —new TOWN OF13AC�A1► r Total Room Count (not including baths): existing new First Floor Rd§MT4Cb6nt Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ i Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Z_ �) 'a��(_T( 1 1 , 1- Telephone Number ���) `7�r Y� 6 2 � Address Q I 0 X D S License # 0 4 -7 Home Improvement Contractor# 1 6 0 1Y6 / r Email 7 Ca-)C shy t . C GV-_ Worker's Compensation # O - Y �- 0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Aoc f nQ/,�t'L— —/2 S c '�-►^��- Air • 6ki- 4daJ1v24 Vi j q SIGNATURE DATE G /. t - + FOR OFFICIAL USE ONLY r ~` APPLICATION-4 DATEASSUED' t a' MAP/PARCEL NO. e s , ADDRESS VILLAGE OWNER a DATE OF INSPECTION: FOUNDATION r s FRAME INSULATION ` FIREPLACE ELECTRICAL: ROUGH a FINAL s PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING I ` -DATE CLOSED OUT ASSOCIATION PLAN NO. Town of Barnstable Regulatory Services " Ricbard V.Scali,Director ° �►��� Building Division Tom Perry,Building Commissioner 200 Win Street,Hyannis,iIMA 02601 ,A-ww.tv�vn.ba rnstablc.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section ?f�sw• ���A�ui�cie*� 1; I i Y1 as Owner of the suiijecr prop�.rt:y rc _ he by atnhonze�`C..\'�� 1�.�1��,(� to act on my behalf, in all matters relative to'work authorized by this bedding pem it application for: (Address of Job) � �� s'�. f nIR ,',."Tool fences and alarms are the responsibility of the applicant. Pools are riot to he filled or utilized before fence is installed and all fold spec i are performed and accepted. nature of Owner Signature o .App cwk- XPnnt flame PYM' L Name. x Die Q;FORM S:OVJNNF RK-70AI SS IOWKX)LS i The Commonwealth of Massachusetts Department oflndustrWAccidents 1 Congress Street,Suite 100 ' Boston,MA 02114-2017 www mass gov/dia N orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERNIIT IG AUTHORM. Applicant Information Please Print Leeibly i Name(Basiness/OTmizationdndividual): Address: City/State/Zip: S 1:�' c 1� M/9 Phone#: f � 9 Are you an employer"Cbeck the appropriate boy: 71) ) � � I a employer with-�- 1_erop1 oYees(full and/or part-time).* Type of project(required):7. New construction 2 Q I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.(No workers,comp.insurancerequired.) 3.❑I am a homeowner doing all work 9. ❑Demolition myself[No workers'comp.insurance rzquirsdj t 4. I am a homeowner and will be o 10 Building addition ❑ hirirha contractors to conduct all work on my property. I wr7l ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.❑Plumbing repairs or additions Tbese sub-contractors have employees and have workers'comp.insurance.: 13.❑Roof repairs L�JL"i9'l 6.❑We are a corporation and its officers have exercised their right of exemption per MCrL c. 14. er �jell LOn1 I52,§1(4),and we have no employees.[No wort-=*comp.insurance required] :Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information Homeowners who submit$his affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit inducing such. =Contractors that check this box must attached an additional sheet showing the mane of the sub-contractors and state whether or not those entities have employees. If the sub-contractots have employees,they must provide their workers'comp.policy number. Ian an employer that isprovong workers'compensation insurance for ray employees Below is the policy and job site information. Insurance Company Name:__ f-R. z - Co . Policy#or Self-ins.Lie.#:_ �,J d S—a, C) O C-) Expiration Date: 2 Job Site Address: WQ.4�71�C�cJi4,.J W City/State/Zip: /114,'ft"t)✓ Attach a copy of the workers'compensation policy decl2rskion page(showing the policy number and expiration date] Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th p is and penalties of perjury that the information provided above is true and correct Si afore: Date: Phone#: . .Z; Official use only. Do not w 'e in this area,to be completed by city or town offuiaL City or Town: Permit/License# Issuing Author' (circle one): 1.Board of Health—.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• office ofc=uioow AM6 mdBusi io�Ps�za-suite sI?o m 116 1a+ T"r. Pfh"c moram E ?l Ci$ n# 2MG4 ET�1N. LATIONt INC.JOSMH LLY P.O. sm 105 SEE MKS AAA 02771 IIPOcAA&4mind .conLMuk fat C 'lip matxxPoymat ❑Lout Card SdNn 4VAr � .da lam$of so Pi�1°t0«��� bdocstis�piraW4d�IIsamdr�atltiatG* C0X7RWMTM psi*cc ON W a�Cae �'sst B s j sobs lA 021" EPH RELLY ! F11t1.1 WIRIdA02f21 "r lea m5 sa6iw3flaaat assachusetts-De atttn M Fent-of Pubiic.Safet? tag ards:. .. . •.• . • ,•din Re :riati&ns and S 'ad _ Board ar e3�ii g g. ' ♦ut�c u�arni JvuCi'7+bT Sidi-scii `' "(" License: CSSL-102771 '' 4 PO Box 105 �@ L `. SeelmnkA- ;027$1.. _ A. Ezpiratic,m..";f. Carnmissi 061051301T,.i. I RETRINS-01 RBLACKI ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(M/201YYY) C 7rz7r2o1s 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 policy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#1780862 CONTACT NAME: HUB International New England PHONE (508)676-1971 aaC No:(508)678-2750 222 Milliken Boulevard AlC No e,n Fall River,MA 02722-9946 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 11 INSURERA:Star Insurance Company 118023 INSURED INSURERS: RetroFit Insulation,Inc. INSURER C: PO Box 105 INSURER D: Seekonk,MA 02771 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. I SR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MPOLICY EFF OLIC EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TV HEN I W CLAIMS-MADE OCCUR X PREMISES m(Ea S MED EXP(Any one person) is PERSONAL&ADV INJURY S GEML AGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE S POUCY 0 JER F1 LOC PRODUCTS-COMP/OPAGG I S OTHER: S AUTOMOBILE LIABILITY C Ea acdOMBdenlINEDSINGLEUMIT S ANY AUTO BODILY INJURY(Per Person) S ALL OWNED SCHEDULED BODILY INJURY(Par accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIREDAUTOS AUTOS Per accident S UMBRELLA UAB HOCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE I ER A ANY PROPRIETOR/PARTNERIEXECUTIVE YIN N/A C08"2.01 08/02/2016 08/02/2017 E.L.EACH ACCIDENT S 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 11 yes,dewribe undo! DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS i LOCATIONS i VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached H mono space la required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE National Grid THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 50 Washington Street Westborough,MA 01581 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ��'� Parcel d Permit# Health Division Qom'' 1 (jj) &I' ' Date Issued 2-3)oS Conservation Divisionh4gFee 5-0 • d Tax Collector � STING SEPTIC S? -- t)il *30. Treasurer L f- •+I r_J.i O__ZL_#OF :�_,_.,.v,-J INIIS Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address Village C��C ���LZ�f'c Owner �' Dti _� Address (' � Q S Telephone S0 Permit Request tc�lyv��( l,�/� y�^� ��� Xld SeCfic— fv ecisfi.�� i t.i ..P Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total=new == c.) Valuation �� Zoning District Flood Plain Groundwater OF eTlay Construction Type ' e1� Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting d cumentation. CU Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes &16`�_ On Old King's Highway: ❑Yes Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name �� w4 Telephone Number Sd — Address L 6a License# VU S lip 9�;-4 " 51m?,`e , "4 A o�(,r,2 Home Improvement Contractor# l'IOC��3 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE OS FOR OFFICIAL USE ONLY PERMIT NO. w DATE ISSUED " MAP/PARCEL NO. , r ADDRESS` VILLAGE OWNER.. t DATE OF INSPECTION: FOUNDATION FRAME �J INSULATION FIREPLACE � Ci ELECTRICAL: ROUGH FINAL c PLUMBING: 'ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING t 5 r DATE-CLOSED OUT f ASSOCIATION PLAN NO. r The Commonwealth of'Massacitusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 .•J° www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Legibly Name (Bnsiness/Organiz ationftEvidual): .. Address: 1 - City State/ZipY� ' �S j� ,:/Nl�:4166YPhone#: c g' Are you an employer? Check the-appropriate box: Type of.project.(required):_. .: ::..; 4. ❑ I am a general contractor and I. 1.El I am a employer with 6. ❑New construction .... employees(full and/orpart time).* have hired the sub-contractors 2. Tam a sole proprietor or partner- listed on the attached sheet. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working forme in any capacity. workers' comp. insurance. 9. ❑ Building addition (No workers'comp. insurance 5. ❑ W.e area corporation and:its 10.0 Electrical repairs or additions required.] officers have exercised their .. right of exemption per MGL 11:❑ Plumbing repairs or additions 3.❑ I am a homeowner,doing all work .� mP P . myself.-[No workers' comp. c:152, 1(4),and we have no ❑ ep a§ 12. Roof r airs insurance required.])red. employees. [No workers' _t comip.insurance required.] *Any applicant that checks box#1 must also fill but the section below showing their workers'compensation policy inforrnation: 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 subcontractors and their workers'comp.policy-inforrriation: I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and;job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500..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 DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofp ry that the information provided above is true and correct. Si afore: � Dater S Phone#: ' Official use only. Do not write in this area,to be completed by city.or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to in service wor er another compensation under for their contract emp hire pursuant to this statute, an employee is defined as ...every person express or implied,oral or written." I An employer is defined as`.`an individual,partnership, association,corporation or other legal entiiy,'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 ' not because of such employment be or on the grounds or building appurtenant thereto shall dee� loY�" MGL chapter 152;§25C(6)7.also sthteslhat"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to:opelrate a business or to.construct buildingsin the commonwealth for any. produced Acceptable evidence.:of compliance with the insurance coverage required." applicant who has not p P...; .. Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealtl not any ofits political subdivisions shall ienter into any contract for the performance of public work until acceptable��dence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please.fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary;supply sub-contractors)naine(s), addres (es)and phone number(s)along with their certificate(s) of ility Companie insurance. Limited Liabs(LLC)_or Limited Liability Partnerships(iLLP)with no employees.otherthan the- members or partners; are not required to carry workers compensation insurance: If an LLC or LLP does have employees;a policy is req�ed• 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 a lication for the permit or license is being requested,not the Department of. PP - Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain'a workers' the number listed below. Self-insured companies:shouuld enter their compensation policy,please call the Department at 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 permivlucense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew 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 bum 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 Departrnenfs address,telephone 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 5-26-05 www.mass.gov/dia Town of Barnstable Regulatory Services WXNBrABLE. ' Thomas F.Geiler,Director MAM �Eo 3+per. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 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 01 . n Estimated Cost Sj Type of Work: /�G� �� `SION - Address of Work: Owner's Name: Date of Application: *4 S I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 []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 IMPROVEMENT 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 o tractorilame Registration No. OR Date Owner's Name Q:fbmis:homeaffidav r °fSF1E Town of Barnstable Regulatory Services - 9� � Thomas F:Geiler,Director p�EDMA'�39. 6. 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 C �' v L ,as Owner of the subject property hereby authorize P 'c' to act on my behalf, in all matters relative to work authorized . building permit application for. (Address of Job) Signature of Owner Date d q ��- Print Name QTORM&OWNERPERMISSION �- :' � ✓/ee.TOovrvreoozuie� a�s��,aaoac�i��a- + + } Skard of 13wtdit+g 12t�ulaG¢roR�Intl Stgh�Fr HOME IMR.ROVEMEI� CONTRICOR Re istkti� 10023 2006 i GREGORY C. GREGORY VAR A - "98 SADDLER LN 4 0 WEST BARNSTABLE,MA 02668 Adminiy[r`.atur P LA NTI�iZ `' (6 ow-(44 w Lv?e, ►tea�s rr !�'l'���s i rr I Z (,✓ erg e w ' ' So IJTTi .►4ev vS444-1s Oak t' / l 4' A. - o o I - . .. • __.._._�.— i - �-- 5` _ �' --•�{ �;--.-----------�- �� Lis OA Pv - b� day ilk S cam. l 1; tA a � i ( 0 -O• � i � � x-r�►�e ow Ll -p k ; ;Zxg iVA � ,,o,c , Vr ` i e � �� • FOIST y, RE 5o ntow�=5 4�wL . y -,.�MRTOACzL, Tf()/V PLA 4y APPLICANT.• DSdIERJlAnT TO YYN MAR.FT om &ILI-5 i E �A `►A LOP 18 LOT 17 t Q � O 40T 13 ASS LOT 3 r►�«4 Oi lt; 4 Su• 44 S:EPri=W ► J. u+ • COYI UFO FLOOD PAN&L.' P50001 0015 C 4700D ZO/v. C`_ DA B/19/B5 °�•v hereby cePWthat this mortgage Inspection plan x�as prepared for. FIYF,' MOR7GAG�' COMPANY, LLC. P� is For the location of the buddin Shown .does _ Bank Use Only 'er taped tncpcecian it a 4 &�� fall n7rthea a spacial flood ddZdrd rune. D�'ED REF' = 785p 001 b tJfeeE at the tame of PPt �VWtrmCjj � res e i-cabon at dAelltr�,, dt� -- cr+afonn to roe local br-&Ws Y001 - is exempt /ram md/o an enfcucemenE net: ndo ct to -h0y QaCeae L ja l fb c*�uLemoQLs PLAN REF. = i1�95 -` ?elerenced Dried sub�at to and mlth the benefit of ell r*Aft *.bet of'aM , ad t Sc�c 7. Scale �u _ nd rl49triceiona of reear� if goy therw ne nod utsotar as the satae are ai I 1 ior+cre and N t� -_s�L� 'F'T. L the V&WiuFW1 as t� Da te.• �r a precise deterzalpdtiod o!the b pcctmw lusts /acetad DY tope nob htstruawt hod ara app dmata aa/jc .1n actual seerny 64 n yy -- used rar r--rding purports or fo lo-P—P and --d e s-mpijs u nay Cxist either tray aerass proper4y lanai This taspeeffoo mart prcincz deed dexript/ons ereJ must apt be used Jor vnrYence ar buiAdinB plan purposes 9?tn upectioo mien not br used to locate PvP,iy linos P-Agrauan of b ply be aecamplLshtld by tm accwrmlo iastramcnt surrey �rhieh lorolt"' property/lac diW-Wo= faros or lot be used tar day purports othdr than mnr 424Y ra&W dlffama, iuformatlon than irhat is shorn hetvwp` T ttoo eao tpa�e Yenkec Serve acne is ro re�y mQ, ulfigg Gum said raGaac tioo is aof j e j rj �T rpaavbtlity Jor)doj j'+x ties�TT °XAX 506- 00-5553 -�L- VKEF SR 6r.Ej 1 ti O1 S Lr A d 1 S Fst SOtJ-4?0-5553 UXIT 1, 40 1s'VDUSTRY RD, .S �4 0. 64b 37010. XJ8 , 6 ® Finis 1 CAN GIVE YOu DEFINITE MAYDE-- PERMA95 TOMORROW? + . o Y , EXISTING v euso ID �0 EXISTING .. EROM ELEVdTk)N - T 1 FFI FI EVdTION IWO Emu mm Ell ..I_ 1 ` EXISTING ® m.oua. .e..uaraw,r, EXISTING REAR ELEVARON m.euar aw.e.m� aa.eroa. — ■c i RIGM ELEVATION BUa AFR MR 8 MRS DEMERdAN DFMN PROPOSED NEW ENTRT AND M43ATH DAIS BEY151Qy DRAWN 1Y PAGE SCALF o sae AooaEns. ✓B DE5/ /75 A tb WEATHERVANE ROW IW2-2004 s - JS •�aF V4•.ro• 9 CENTERVILLE MA, rravwuww.weeunw nwueet aexvweu wv cmrrtrara vn�u reaer ela umranwparQ)v m.0 tdCeeawolma w�emen000n.w aavures•voeau 1eviaeevmmu rmrae xmumoerrax eoi�mmwsuo vevr.na 'w�wrrom.m w.uammenovnrwruevenvr perm rarmonwwsev navxw naeeaum�ee aw o0erae+�raa rrunvewcwmmeox.an wrurvnincu emxrn. rar'u mwin�aemmo�u� mie.mauae nwmw ewl.aom M t]S@TItl4 j seta O 0 0 e E:namla Emma M,II E7SIGIQI6. B ® GQCdIEIi EAiQi9.AeF6 @ 9F eIDSQan �/�1 m.lwsolu IIIIttt E I ° �i , ----------- - - - --- ---- mum m ��vJc9..lu. BBCOND FLOOR PLAN e� cpv.�euu•�� ; U.....i u..Wb........... ........... `6 �s• rte iw• .c. id • -. I I �II I FXI.T.bcT.•�. - ; I 1- 0 EXISTING �=ey,evt nui�� rc.le0v I EXISTING uawm' p...e=..............e ....................... H'k»•.OIr.11t i I ------------------ ----------- I ' fdT�.1®MUtUp � I _ �TNG FOOTING•DETd.B' -ON RE IIAI L I m.r•..p I I FOUNDATION PIdN I _______________________I I 81 �e eDORE44: MR I MRS DEMERJIAN D 4I.N PROPOSED NEW ENTRY AND M/BATN QAM Y P..Aa !CALF A ab WEATNERVANE ROSO 11.02-200I JB CENTERV .2 oc V4'.I'-0' ✓B OL�S�/15 ILLE MA. llacumawu�`.`�'Ot .rrceeeuc�.l.wkm.nl.0 ,Doom u.wm.nsax+la•ucarw.n r..m+. .u•o.eles.imwlcoi..mee�.rmeuca Ivralweu ro.,�•..mro®e.larmrammw.w.crm.a. 01'u�'mommnroa+ua.as+orlw l..mcaarowa•ro.mwowx..•mua nlsro4 +wrrokr.e..er+x.wlxu m4ew. anla�nfl„^o"•rl�mm��le® e•mcl.0 n�aar 1 K rs'�-p -e ROOD DECK _ ' I,I ' I f r 7 I I .l / 1 ! S Si ! � r ! r S r + J Y'T>•.� _ 1 rM w'ayas wm wn EXISTING 1 1 S I 1 1 S 1 S. % 1 1 1 1��S 1 + ! M • w®n J • f / 1 r I I l r + r + l r' r l l ! S � 7 + ""m• _ ING 1 �t • __. . . . . . 1. .1 r s . . ; . i . . :' + 77 { is . { U EXISTING� �.e � � � . { $ { r e � _ ;_s_!_;_ _r _ _�. �xAEPNALT 9N61WFA 1�++ � ten. �^»^^' "' •rt vu NAEPWII PAPER Vl PLT.BREAINIXG ' no 1 OOR dMM• LAN - I I e - VENTED DRIP EDG g'AL161.WRER FACIA F- 1 IX EORiTWI BED t40. FREBE ------i QD 111 • 4W-.1 } R6vmAnnn E i ®D FAV DF�F�AII ' tT rLiww ENIBY !®Y I WV . YIw Mr.i. ' NLLlG�d1(D. , .mit. GOEMALL b TTVIX OR EOGAL _ '-loll -1 w1rGe/9. � l` _ WPLT.&�4TIWO ��� rR0%SFGTION�1 '< COAR E8 8TARtER codas¢ 1 Dt6 P1.EEL =6 Eel REALER • r M8*ANCHOR DOUR •6'OZ. J�J c e . ��� )Z D wiT ncTAn6 '7 DAM R V Dng�wx er e a r� ✓B �115 &aADDRESS. MR 1 MRS DEMERAAN QE51G11 PROPOSED NEW ENTRY AND MISAT14 IL DAM 4 pJB * 3 V4'.f-0' 6 J6 WEATHERVANE ROSDGENTERVIILE MA. i n.a+.eean.mmuwwr.wv,.aLaw • umn.uaEmmaa NOTE: a.n+. monu,�6.uc.Leoa�•mmei+..o �u ouax:nm ewonaowm+naw anm on.mu nm""io rvne"va�ann�meoa.wen mmun.auL en.�L .w mwa alu.0 II` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Gam^ Map '7 Parcel �;, �,. Per # Lrz_� Health Division Date-Issued Conservation Division Q v `' f !Application Fee . O U Tax Collector Permit Feeor Treasurer EXISTING SEPTIC SYSTEM Planning Dept. LIMITED TO 3 #OF BEDROOMS Date Definitive Plan Approved by Planning Board "S Q,v �o �, -i - Historic-OKH Preservation/Hyannis op,-A n,.'p ,6 lelow. Project Street Address 'a(0 we- V A n e. Village t�AKStarlS Owner 12 ',ct+liz ,0 / R.` C- OC-N1FnStddress I (IC_1 MOe< c Telephone s38 __T66 C-6 `P 3 ( ,kri-q L)M_C i PM- Permit Request d001 _'ION /VA,1 i M i C- i O2. A- f C-1t f IZA� Y x �s eL u j ?QI► ccf-yM4 Square feet: 1 st floor: existing j 21"6 proposed 3 2 2nd floor: existing proposed Total new 3 2 Zoning District Flood Plain c' Groundwater Overlay -- Project Valuation r l o���- " Construction Type W000 Lot Size 4 000 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family O Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ®-No On Old King's Highway: ❑Yes .®No Basement Type: 1I1 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) qy Number of Baths: Full: existing 2 new — Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing 1 new First Floor Room Count Heat Type and Fuel: aGas 0 Oil Cl Electric ❑Other Central Air: ❑Yes WCNo Fireplaces: Existing f New Existing wood/coal stove: [ 'Yes 0 No Detached garage:0 existing 0 new size Pool:.®existing ❑new size Barn:l#existing ❑new size Attached garage:O existing ❑new size Shed:Erexisting ❑new size — Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded 0 Commercial Cl Yes ❑ No If yes,site plan review# Current Use Proposed Use I BUILDER INFORMATION Name_ Eyl; P(\%eJ LL- ` Telephone Number6� •�,2� `�'��'� Address 6 . o k �16 License# C S Off' 3 CAI„,�t A, ►M U2 e3�- Home Improvement Contractor# 1 3 3J Worker's Compensation# �S�S 3 6-1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE l( � /0 Y FOR OFFICIAL USE ONLY ERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION -T�( Lo!( 2tz y FRAMEJ%.2iel INSULATION FIREPLACE 4 • ELECTRICAL: ROUGH FINAL PLUMBING: ROUGHe, FINAL : GAS: ROUGH,, t FINAL Ca) (n FINAL BUILDING t, t� rr DAT&CLOSED OUT p 0 ' ASSOCIATION PLAN NO. :E � Y ' The Commonwealth of Massachusetts ? i Department of Industrial Accidents _ - 600 glashin;ton Street R �> Boston,Mass. 02111 Workers' Compensation Insurance Affidavit-General Businesses y' riirr i�i r ' rrraiiai r r / r acne• . . •• address: state: 2a : hone# work site location full address: ❑ I am a sole proprietor and have no one Business Type: ❑Retail❑Restaurant/Bar/Eating Establishment working in any capacity. ❑Office❑Sales(including Real Estate,Autos etc.) ❑I am an ern toyer with em ] /// es full/%%/& art time). El Other / /�/�/%//%% %%/ ////, �I am employer providing workers' compensation for-my employees working on this job. ,::... . .:. .•�..' • ••� t��+cam'• .�:'�` . eomvan name• �'� address � , ' .94 city. .... - �::•�'. . lnsurence.cod / / /,l// . �] tractors listed below who have the following workers I am a sole proprietor and hoye hired the independent con compensation polices: coin-'an name: ..,, .:> :. ..ri..f• .;is i•: .. address: hone# : city':. 'insurance co. •• -.,.•._.. . .,� • : ..� i.. .JJ corn"an. 'nsni •� �:;•;, :,..• :. .. address: hone#i // / /// Fallure to secure coverage e9 required under Section 25A of MGL 152 cen'lead to the imposition of criminal penalties of a flee up to 51,500.00 and/or. In'U one years'tmprlsonment a+s as cfVi1 penalties in the form of a STOP'wORK ORDER and a fine of 51U0.00 a day agafa+t me. I understand,that a copy of this statement maybe forwarded to the Office of Invntigations of the DIAfor coverage verification. I do hereby certify un thepains and penalties of perjury that the information provided above is true and correct Date /1 10"' `2 O by Signature_ ('Print name Phone# �t aY� !�"� official we only do not write in this area to be completed by city or town official 6�r permlttuceme# ❑Building Department city or town: ❑Licensing Board ❑Selectmen's Office ❑check if immediate response is required ❑Health Department 5 contaetperson: phone#-, ❑Other (revved 9epL 20M) - ' Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employee person provide service of another under ensation for their contract employees. As quoted from the"law", an employee is defined as every p Y 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 apartmerits 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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 listedbelow. 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 Investigations has to contact you regarding the applicant: Please be sure to fill in the per"it/license number which will be used as a reference number. The affidavits.may be returned to .. the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank ybu in.advance for you cooperation and should you have.any questions, please do not hesitate to give us a call. . The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents WIN ofImsugadons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext.406 °FTME►° Town of Barnstable y � Regulatory Services BARNSTABLE.ASS.Mass. Thomas F.Geiler,Director MASS. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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: 0" Estimated Cost 3`2 75t> Address of Work: M.z W e'PrI\e'VA n e \lk3"92:11 Owner's Name: I '11�(�t e Imo• c�„�ar� 1X/iw► Q ,(� A� Date of Application: 1 1—lA - 7,bC)J I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit I Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT 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: I I t(6/'2 C—n,k/ff)V j Date Contractor Name Registration No. I i OR Date Owner's Name I Q:for ms:homeaffidav i RESIDENTIAL BUILDING PERNUT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 �50,a O Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= z.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= S O O Cox.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120.sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 y� (plus above if applicable) Permit Fee Projcost Rev:063004 nO CMR Appendix J ' Table J&Llb(continued) Prescriptive Packages for One and Two-Family Residential Buildings Heated with FossU Fuel MAXIMUM MINIMUM Ceiling Wall Floor Basement Slab Headng/Cooling Glazing Glazing B B B Wall Perimeter Equipment Efficiency' � • R-value R-value° Area /o -valuer R-values ( ) U Package R-value° P.-Value? 5701 to 6500 Heating Degree Days' Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 !0 6 8S AFUE !5% 0�6 38 13 25 N/A N/A Normal U 15% 0.46 38 19. 19 10 6 Normal V 15% 0.44 38 13 25 N/A N/A 85 AFUE FUE W 15% 0.52 30 19 19 10 6 85 Normal { X I S% 0 32 38 13 25 N/A N/A Norrmal Y 18% 0.42 38 19 25 N/A N/A Normal Z 19% 0.42 38 13 19 10 1 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above):. i' NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a I 780 CMR Appendix J s Footnotes to Table J5.2.1b: I Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area, expressed as a.percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. Z After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U=values cannot be used. ' The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof.. 'Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 5 The floor requirements apply to floors over unconditioned spaces(such as.unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must mctE the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ° If the building utilizes electric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. .. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a) Glazing areas and.U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U=value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 i I I MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 Release 3 I I I I I Checked by/Date I I I TITLE: Capewide Enterprises Inc CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 11-4-2004 PROJECT INFORMATION: 26 Weathervane Rd Centerville, MA COMPANY INFORMATION: All Cape Insulation & Supply Inc PO Box 645 E Dennis, MA 02671 COMPLIANCE: Passes Maximum UA = 24 Your Home = 24 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 35 30.0 0.0 1 WALLS: Wood Frame, 16" O.C. 130 15.0 0.0 10 DOORS 21 0.550 12 FLOORS: Over Unconditioned Space 35 30.0 0.0 1 HVAC EQUIPMENT: Furnace, 88.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4 .4 . Builder/Designer Date I GF, _PLA APPL.IG'ANT. DSMERIIAN TO WN' MAR.STON,s' &TLLS L02' 18 • V LOT 17 nr1 R ' z ffSC• I Jr (---POOL— Cr. r�6 10 LOT 12 ASS. LOT 3 ►►►AAAa� i - COY' ► F600.0 PANZL- 250001 0015 C .'ZOOD ZU1VF,.' �___ � V�vrY ` J � ---------•--- DATiZI' B�IJ%B5 f horeby eerti1°y that this tnol'lgraae inspection tan ivas S_4I,EJ�! FIVE MORTGAGE' COMPANY LLCp prepa/ed far Phan is For _ Dank Us(,- Only T1ic 1oc4tioL of the building shot✓' .does _ r_ fall within a �pcclel !laud hazarJ cone. i F2r tapcd irvpecuon /t appears rae location a/ a,I,&n�* does __ ,__ DEED REF = 785�_(JU1 — In eflecl st the time of eonstruc•Llarr with nespaet to horfrontu/ dime-tX40 olrm to the satbsck reocal ui by—laws or is exernpi lrnm violation cnforccmcnl aeG'uP undor Mays, CcneraJ Laws CJa 1tJ _ 4 r'ones PLAN REh' _ ---- !7Elcrencad Uecd subject to and with ibe banelil of all rjght2 r4hts of•wad; eas•enrjenc, rrierveL'or;s Stale 1 and restrictions o! record, // any thorn ne and jnsvlar as the some are of /ckel force and oflaeG g Date: PL _15104__-- b'ASS NUT(` Tha slruetures an this InspreElbn'Wyre Juretod by tape not lrvtrumeat and era approsimatd an/y, rlrt actual Survey is naeeyyary fore precis: datarrainatiaa of the buildln� /aeatlan and eacroacJuncnk,, !f any exist either Kay across piuperty lures. This iSurve is em-II not Le used tur reeordmAr purposes or for use in preparvng weed de3cripU0I ayd ,Huse Put be usdd for vat/anee tr Imei.a7 plan purposes. This only e a ri;uyt not be uacd to locate preperty lints. lrerifjcallo,2 of buildinb, locatiolz;; property!¢fc din -cns, buildsfent-v or lot purpos-IIcanti n can only be at-"I by an accuralc instrument sul vey which ritay collect dilfccent utformaL(ua than wYtut is shown haraart. This iaspcction (s Hat to be used for any purposes ooLber t/heinn mvrt8a�e. 11-oik`tccf Suf•vey aecapts no rospor�Jbiljty for dame�ey ,rc::ultiLy�lran; said rcliJnce. PHONL: 5lJB-32 b-•553 1 L. V VT / 1 j l �7 (_j 1 CV.L y rJ� L 1 1 ti 7 FAY sat7=ado-5553 UATT 1, 40 INDUSTRY RD, MAR.ST0IVS rY1lLGS M_1 0-1 370.10 R!B TO 39dd A3l Nns 33ANVA e5550Zb80S /_F:FA bRGl7/T7./FR i of"E to Town of Barnstable Regulatory Services BM UNSTABLE. ' Thomas F.Geller,Director Leo 3 a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 i Property Owner Must Complete and Sign This Section If Using A Builder -��I� l/ , as Owner of the subject property hereby authorize. to act on my behalf, in all matters relative to ork authorized bythis building rmit application for: (Address of Job) Signature of Owner Date Haf- r 1 ,e A , L)eMter' ►a v\, Print Name Q TORMS:OWNERPERMISSION L i gal TIO,NS gyQ'A CONS BRUCT ON SUREJR ISOR License. ! 089 �,� 273 } Numbi ei %� .07 Tr.no: 69273 RICHiARs 205�BIACKgTH©R, Njp;RST N MIL=L-S '2 Commissioner ' -Tlee elmmwou"'a o�✓�aaoac/z k3' i Board of Building Regulations and Standards HOME IMP ZENT CONTRACTOR Reg 358 i6 Ye'L 4rtity Corporation , i CAPEWIDE ENTER ' RICHARD CAPEN _ 205 BLACKHORN RD MARSTON MILLS,MA 02648 Administrator I ���^^^'Mrs/ "►'�""�G°ti�'��IC�`�i'I'y''�P' "'r 3 -' /i°�MM'+T�'���' ��'rC�Fr�v"--wr^'y'.�q�,,j���_'r'�. TOWN OF BARNSTABLE Permit No. ......3 28 BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ,.. ,Ml°670• X ��e.►+' HYANNIS,MASS.02601 Bond y CERTIFICATE OF USE AND OCCUPANCY Issued to GREENBRIER HOMES, INC. Address lot #18 26 Weathervane Way, Marstons Mills 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. January 29 19.9=............ ........ " t .................. Building Inspector 1-048 DATE Ue ��r,ber 91/LICANT Owner t9 PERMIT NO. .T9 Y ADDRESS (NO.) (STREET) PERMIT TO Build dwe llins:; I ONTR' UCENSEI (Li-) STORY Single family dwelling NUMBER OF(TYPE OF IMPROVEMENT) N0. DWELLING UNITS (PROPOSED USE) AT (LOCATION) lot #18 26 Weathervane Way, Marstons N,ills ZONING F (N0.) (STREET) DISTRICT BETWEEN (CROSS STREET) AND SUBDIVISION (CROSS STREET) LOT BLOCK LOT SIZE BUILDING IS TO BE—FT. WIDE BY ' FT. LONG BY FT. IN HEIGHT AND SHALL-CONFORM IN CONSTRUCTII TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION REMARKS: Sewage )91-530 (TYPE) ARAVOLUME 816 sq. ft. BOND (CUBIC/SQUARE FEET) ESTIMATED COST $ 45,U00 PERMIT $ 65.50 OWNER Greenbrier Homes, Inc. . ADDRESS �• 0• tSos entervl e j�?;'� _ BUILDING DEPT. y •1�/d I 0. THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER 'TEMPORARILY C PERMANENTLY, ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE Al PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES A L FROM THE DEPARTMENT OF PUBLIC WORKS S WELL, AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINE . THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDIT 101• OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALLT -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: D KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR 1. FOUNDATIONS OR FOOTINGS. E. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCT ELECTRICAL, PLUMBING AND MINAL IN (RE INSPECTION TO LATH). RED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL 3. FINAL INSPECTION BEFOREAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS; VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS I ELECTRICAL INSPECTION APPROVALS 1 D J z z z � X 7z 3 I HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT S s✓.YA Zr 7a �,iL.rt -2�y RD OF HEALT OTHER • Jtv`// /Q/'� SITE PLAN REVIEW APPROVAL WOW RK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION T HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CONSTRUCTION. INSPECTIONS INDICATED ON THIS CARD CAN-BE PERMIT IS ISSUED AS NOTED ABOVE ARRANGED FOR BY TELEPHONE OR WRITTEN NOTIFICATION. LOT 17 �P TOF ELEV. =102.6' 1 'O. LOT 18 43,561 sq.ft.f r' LOT 12 { x 1 12 3 91 INITIAL ISSUE CF THIS PLAN IS NEITHER INTENDED NO. DATE I DESCRIPTION gy FOR, NOR SHALL IT BE USED FOR AS—BUILT FOUNDATION PLAN—LOT 18 MORTGAGE LOAN PURPOSES. WEATHERVANE WAY BARNSTABLE, MASSACHUSETTS FOR or jw GREENBRIER DEVELOPMENT CORP. v�'�` SCALE: 1" = 40' JOB NO. 1599/1599 1 CERTIFY THAT THE FOUNDATION 1o1 PAULA. ^�� SHOWN ON THIS PLAN IS LOCATED LEVY .� � 40 80 i ON THE GRO D DICATE v I No. 10617 i LEVY, ELDREDGE & WAGNER ASSOCIATES INC. ec� s auc�ee CNr � PWNNS WDREGIS D LAND SURVEYOR TE sURVMRS 889 WEST MAIN STREET CENTERVILLE, MA 02632 DEPARTMENT OF PUBLIC SAFETY COMMONWEALTH 1010 COMMONWEALTH AVE. OF BOSTON,MASS.02215 1W.f ENCLOSE CHECK OR MONEY ORQE(*i s<34 t .. ......, ...• -::,..... ..,:.. :•r•. t....t ;,+•t+istKtiRt2tndtftses;'ri+!r..t�i,.;Kk. rtst tkt !�t' rd�trl' . ... .•.+ , .:u t <{'tt1iits{ifs?tfSlh{2tt{Kk�k�k� r�+•••-•3R S}:!t'.t!Cx..(S£cC>i'•: a�I•<':?Cfk:�tt -t+.• .. .. .,: :.t!.`'Atk�is+=t •s<Ek�' U F CAPE - THE GREENBRIER CORPORATION 1550 Route 28 10 Center Place P.O. Box 510 Centerville, MA 02632 (508) 771 -3616 �,. qL r` •` \ram .. a,�' . ' 1 .\ .i V- �Y . i ��' l� .� If • � t �T r ,•�, ,zoc E D,�i «�.."C S � zEC-f I " � 1 1 1LJ1 c 1 � 1 0 1313 wR h1 O A i i as ' t 1 1 1 { ti yro'o a ral I - ��a� ��v � �z.e Ys'ca' Y}..•�•{ t�t:ic 7-4 • I �Ar L�. I � 6�-� 1 II a: ��•}�t _ �t s �f^CP'1' ..(-� ��.a� S I t—J- . ` �s�rs•t'rd:t.�f+-olTYP�. R� � � _ 1i--F�ft=--• _ ..•: � ,� Is _V 1---� ` —� 1 � —— -— _ _-- I � .35�: l�G.k<.vs ��ICyfi"!O•cr�rL�"'�" 1 CI I .. i��+-.t.ta+i+ �+n'�{ - ----•- _' P-���•+k at•�..FMittif�{�Yn ? �i - ���'�� .... - grossa Q � .. . gyi p .. .. . . .. ee - 5eT N � I --6 E pITOONf ' � 6 d71C00►�1 " ... _ ..PF-e-K .... \� -- ---- C pp �- ca _r. II°: - 4'vl F" r risu_ _.w IrY IL 1--L-- ------- -- _ r x — -- I UKsn.da� �I LAW 4)4- /v— - 9/ f9 Assessor's office (1st floor): `7NEt ff....0... ..� EP W o Assesspr's map and lot number ...�..�... T.' Board of Health (3rd floor): �n /� rA ��1�jq STE�� Sewage Permit number .. ,. .......�./..........(�.......�..� .. . L �NCD B T&BLE. Department De rd fl MP Ca Engineering pa (3 00 ). EN House number ..........................................�..... WRON�ENTA� 'EOYPY d\ k a 3-------19-----y YO N RE CO AND Definitive Plan Approved by Planning Board ---- � __ _ �/ ODE APPLICATIONS PROCESSED 8:30-9:30.A.M. and 1:00-2:00 P.M. only' '' nly � OV��ONS APPME°TOWN OF ' BARNSTABLE some" 4ftillevation Depa;t DUILDING INSPECTOR BiQt► PLICATION FOR PERMIT TO ...... �Cr 11 TYPE OF CONSTRUCTION ....5 rN U�6.... `r c r7 �!!o o!).......... �.•rE .. .................................................... ................................................19. W. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Caj /j !F �/c�r�'Fcv�.,F �/�� ��sro.ys ruS ............................................................. ..... .................... ......................................................... Proposed Use Ss"itr` / `"Fc c I.vL :......... ......... . ........................................................;..................................... ZoningDistrict .......................:................................................Fire District .............................................................................. Name of Owner . . o�Es q. ... �►• 376 5"!0 .....�� ...r�L� .......j..... ...............Address .................................j.. .......................... Name of Builder .......Sn^'ee .......................................................Address .................................................................................... Nameof Architect ..................................................................Address ........... ........................................... Number of Rooms ..................................................................Foundation ......fyt.u.v.e ............ L�-e . ...... ........................... Exterior c/a daa� ce,�/ar or- v% rp . ^"��)j.W..C..S.`:"f ..Roofing ............. ' . 2! 6 Floors L .Interior 5 �...�.::�e-� ............... ...................................... . ..............................:....................... NQ %G-ems-- Z b•0 Gloms' Heatir; ........ ..... .........................................................Plumbing .................................................................................. � a� Sys 600Fireplace ......... n� .- ................ .................................................. Q/ Area .......u/..4....5- ......... Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Tow f Ba nstable regarding the above construction. e � Name Construction Sup iso s License �0..3..`� A GREENBRIER HOMES, , INC. Nb��.�.47U... Permit for .. 1 z;. Story........ LelTinq........... .... Location lot...#.J..8.�.... .6�.Wea;t.?hervane Way ...............Mar.stops...JVi'VIs.... ...................... Owner ...Gxe.sxlb.X1��.. 0?l1eS�...I.l?C.a...... '<� 1 4 ;1 Type of Construction .....Fz.amo ...:....:.............. w c - ;: ..... .................:.,..........,...:.....:................................. Plot. ............................ Lot .............................. Permit Granted Decembe. . . r...3.., 19 91 .... .. ....... ..... . r Date of Inspection 009 C-1....rl..(........19 Date Comple ed ....G.... ..../.... ....19 tie . UPDATE PERMIT RECORDS : ADD CHANGE DELETE PRINT FEES HELP END CHANGE RECORDS IN PERMIT TABLE PENTAMATION----------------------------------------------------------- 12/08/04 PERMIT NO. 67669 PARCEL ID 147 048 26 WEATHERVANE WAY i PERMIT TYPE BPOOL BUILDING PERMIT POOL DESCRIPTION 18 X 40 INGROUND VINYL LINER STATUS C COMPLETED APPLICATION DATE 03/25/2003 DATE ISSUED 03/25/2003 EXPIRATION DATE DATE COMPLETED MASTER PERMIT VARIANCE VALUATION 24000 . 00 BOND 0 . 00 CONSTRUCTION TYPE 329 GROUP TYPE 1 CONTRACTORS 077899 ANCHOR DESIGN AND POOL CORP. ARCHITECTS/ ENGINEERS/OTHERS ENTER Y IF ALL ARE CORRECT OR N TO REENTER LEAVE BLANK FOR NON-PROPERTY RELATED PERMIT. CTRL-I FOR HELP. r TOWN OF BARNSTA'BLE BUILDING PERMIT APPLICATION Map - Parcel Dy Permit# TOWN UE BARNST�B Health Division i Date �ssu69 95_0_3 Conservation Division 3 II C05 170,03 MAR 11 fLeQ_9: 5 lU a i Tax Collector Treasurer k N) L_ 3 f//h3 11 D1 l S, WSYSTEM MUST ES -�_ INSTALLED IN COMPLIANCE Planning Dept. N H TITLE 5 Date Definitive Plan Approved by Planning Board Egg VE11014MENTAL CODE ANE Historic-OKH Preservation/Hyannis TONIV,:I F',7vp-+LP 710MIS Project Street Address 260 4/_4N ze__ AI)4 Village Owner Address Telephone 0 Permit Request ��3 �L(-'4Tr20^V 14A,) I)e yU Lf Q 2 n/A ; u S /� �0�^� �L ✓ M.-1�� plod'.L. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House:. Cl Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other 2 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 n� ew size / Y//0 Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION / Name- 12 ' "Uls = I 2-�G� Telephone Number Address / y3 L4 fP82 611"v y *20"'-0 License#O 1Y 4 D2U 7 Home Improvement Contractor# / 3 Z 417 Worker's Compensation# /,✓CC �� �-3�/d 1 Z� �, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Sf T S ,� ENN �S ptiLy SIGNATURE rX '/.n,..o �c/� DATE 3 7 6 r FOR OFFICIAL USE ONLY 6 i PEERMIT NO. DA,"l>;ISSUED ! MAP/PARCEL NO. ADDRESS VILLAGE OWNER . DATE OF INSPECTION: FOUNDATIONbK ' del s FRAME i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH'? FINAL GAS: ROUGH d FINAL FINAL BUILDING tr3� DATE CLOSED OUT t 3 i i €l ASSOCIATION PLAN NO.Iu� :> z 3 g . z The Commonwealth of Alassachusetts � ( 6 Department of Industrial Accidents - Office 91//fYeSl%9abens 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit erg name* locationd city / /ZG zL-1A phone I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity an employer providing workers' compensation for my employees work', on/this job. company name: address: /1•J ff� city: �c-�/N�s Pa�2�/Y�1 eqw&hone#: SDI' insurance cu. l.J /4 ?00 policy# �s'SCJC - 7 L/l/S c-0 I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: address: t3 phone#• insurance co policy# c address - city- phone#: insuranceso policy# _— Failure to secure coverage as required under Section 25A of N1CL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penaltie in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded tot e O e of Investigations of the DIA for coverage verification. l do hereby certify under the pains nd en ti s of perjury that the information provided above is true and correct Date 3/y 3 e Signature X Print name / r' v �—L Phone Cofflianly do not write in this area to be completed by city or town official permit/license# —Building Department Licensing Board mmediate response is required Selectmen's Office Health Department n: phone#; —Other (r v,sed))95 P)A) i Information and Instructions ` M Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as everyperson 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 section 25 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, 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-in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits 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. . c.• ++.!::.. S 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 Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. i _ :� i .:'. 'rs'`-:.:tiw.•i••�•'fZ: WON The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of imesfigations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 i F1ME r, , : . The Town of Barnstable ,• anferrsenai.E. 9 M g Regulatory Services 039. �`m Thomas F. Geiler, Director QED MP'� Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date 3 O- D 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. Estimated Cost Type of Work: n/(�✓1oti sw =�� Av L 2 000 Address of Work: Owner's Name: ��— Date of Application: 3' D -3 I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby appl for a permit as the agent of the owner: 772�-, 3 � Dae Contractor Name Registration No. OR Date Owner's Name q:forms:Affidaw rev-070601 i .��e 'Garit�rx�yre�ue«ll� o`��it�+�4�arl uaelro Board of�Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 132476 One Ashburton Place Rm 1301 y� Expiration: 2/13l2005 Boston,Ma.02108 Type: Individual TIMOTHY RICE TIMOTHY RICE 138 Lumbert Mill Rd. GG F - „ r�frwi Centerville,MA 02632 Administrator No id with ut signature I `'� . ✓�e '�Fr.��»r»ro�acUeca.��� c�✓!/��kiaCltccde��i sup. .: t oarcl of 1;tli ld.ing Regulations and Standards Dnf- yl: .h1_)t.jrt�place - Room 1301 0 >'' �n . Massa iusetts 02108 oven nt COnt ctor Registration Regi tratio,'. ' 32476 Expirat 02/13/200 G /� ✓f�na��„��� Yt�r;, Incliv 1. al HOME IMPROVEMEMI LOURALiOR Re9istralion: 132476 T I MOT I-IY F:I i'f: Expiration: 02/13/2003 TIMOTI-IY Rlt:E type: Individual 197—B RT . 6() DENNIS MA 02 8 ICE J In01Hr R 5�'� �' 1•B RI. 6A • AD TOn c DENNIS MA 02638 ��.• G+n•m mi+riinr�l/� ��..•l�iraii�r�ndv//d BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR t Number: CS 077899 BIrthdate: 08/2811969 Pplres: 08/28/2004 _ Tr.no: 77899 Restricted To: 00 TIMOTHY P RICF_ �/ .,/ 197 D RT GA •�' DENNIS, MA 02638 Administrator I I FROM FRX NO. :15037503459 Mar. 21 2003 03:55PM P2 MAIl21 -O3 03:>R9I? A00 Ii.. PRODUCAR � RTIFICAT'L OF LIABII.I INSURA • NICE � � OATE(MMIppJyy) )!SC$heAt IOOtaretfv� Agency, • Ina. THI$ CRISI Will Ill 18111�gp A6 q MATTER OF NFORAIAT qN ONLY AND CUNPQRB NO RIpNYg UPON THE CERTIFICATE 749 Maio $tzeat; . Suiteon 1 HOLDER, THIB CERTIFICATE DO&R NQt AMEND, EXTEND pR Oliote>r'Vi1]_eI, ma, . 0$ 55 ALTER THE COVERAGI All DO D-0Y THE 0��1011 POLICIRB 4ElOW, INBUREAG API.OltD(Ng COVERAGE fNEUAro Anchor D®si p & Pao" InC BUNRRA: "^—.. „ rNSURrne: $ � I>�rilZMoo.- =y , 143 Upper Cl Road —C rDQ i,,.t.�+Rr1°,>�zom4DnY DOnainport, MA 02639 INSURERR INSuIeeP COVERAGE$ INAURFRt: lOystra ?n19 Cb. POLIC THE REQUIRE E INSURANCE T RMVCE LISTED CONDITION O HAVE BEEN IBSUEq TO THE INSURED NAMED A13OVE FOR THE POLICY PER[ INpICAT>D,NOTWfTHSTANDINCI ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR 01I DOCUMENT WITH RESPECT YO WHICH THIS t;P.RTIFICATE MAY 1IE ISIIUED IN MAY PERTAIN,THE INSURANCE AFFORDED BY THE POL'CIEG DESCRIBED HK REIN 1S SUBJECT TO All THE TERMS,EXCLUSIONS All POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE I REDUCED BY PAID CLAIMS, CANDITIONS OF SUOR CH TVPBCPIKSU1UW BC —"�• POLIG1f NUMBER • QENBRAI LIABILITY Will COMMCRCIAL 00011 a LwIll rACI1 OCCURHlNc CLAIMS MADr OCCUR LIRE OAIMBE(Any am Gm) I /O da A — _ OBtl8NQA9399 MeoexalAnYo�ePaIlan) BS_QQ0_ 04/34/03 04/24/04 PFASOII&ADVINJVRY t 000 016,11111 AOnRECATE UMR APPll fER. 081NERAL AGGIl Te 52 POLICY AR LfIC PRODUCTA•COMIll ACI 6 0,,D AUTOMOSILe LIABILITY ANY AUTO ' COUDINIM SINGLE LIMIT ALL O WNEA AUTOS LEA allI I,.0 0 0,;010 1 BCHtDULEDAUTOR (IINJURY i B MIRED AUTOS NON-0vuuanAUrUe V67642. 6 07/11/02 07111/03 ZDILtlI0mmIul P13RDFRTY DAMACM fPa Ill OARAar UABIL.ITY AUTO ONLY•EA ACCICT NT A ANY AUTO - .• QTl TNAN CA ACC f AUTOONLY: All4 BlcCes9 MAI►ILm EACNOr.CVRRENGE $ 1000�CACCUW F' ICIAIMBMAOr AgORE13Al'r _ f 000 fXCA4961 04/09/03 04/09/04 4 �' bEDUCTIBLk I •- S NBTENTION sin nnni waNIIBRe OOMPRNBATION AND f EM►LOY11l LIASILITY )( �WCC5001392012003 04/09/03 04/09/04 1SACMAOCInIll f � D r,1.019CA8E-to EMPLOYCR_U0110 oTNRR E.L.DSFA6k-PDLIQY LIMIT Sagaug i OEf<CRBPTION OF OP6RAYIONeILOCATIONWENICL!l MCL U810NB AODRO OY RR*=lRIIII@I gCjAL P I101Al CERTIFICATE HOLDER ADORIaNAL INBLIAll INBRRRR LRTvrRI CA►ICE;IIATION iNOULA All OF TNR A31I DESCRIAEO POLIdRA BB CANRlLLBO BrFORS rl ikMRATION RATE W10111 F,TO IHUIll INAVRr1IVALL rNORAVOR TO MAIL jLg_DAYS WIl TCMM of 8111 rus t ab 1 e f NOTICE TO TN!CERMCATA Nf 9l NAAICO TO TN6 Leff,BUT FAILURE TP O0 60 SMALL Bu12ding Department IM►01r NO OBLIpATTON 00 LIAe1LITY Of ANY VINO WON TH6 INSURER,ITS ARENTS OR 1114=Wtable. Ma. 02630 RRrwn�ITAnvw. Atf►Il MNM RVRBBRNTAyl ACORO gel(7107) mA ORR1 CORPQRATION 18ae FROM FRX 1,10. :15097603459 Mar. 11 2903 11:55aM P2 'own of Barnstable ' UAFNSTAALE, •Re ulator Services = K".& Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L YAAe-?w �D�� ,as Owner of the subject property hereby authorize z&AAgAL �to yG,y 'W /aoG _4R to act on my behalf, in 4n matters relative to work authorized by this building peanut application for(address of job) Aleomm 71- Sig&t1Jv of Own D _���//-dl . ate Print Name i I # 25 ��1 N�STANDARE:not all ID LEGEND s will appear on a map GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH ORCHARD OR NURSERY - ^� EDGE OF CONIFEROUS TREES MARSH AREA i �Pn \\ EDGE OF WATER DIRT ROAD i / ^ \./ �•, \ DRIVEWAY PARKING LOT PAVED ROAD —--—-- DRAINAGE DITCH / - — ———— PATH/TRAIL iillAP 147 PARCEL LINE ** AlQ�r M1P 110�—MAP# 21 E PARCEL NUMBER +iIUD ' HOUSE NUMBER i 2 FOOT CONTOUR L1NE - _,� QOa =2 10 FOOT CONTOUR LINE C-er'`�'U���,` •� ;�4.5 SPOT ELEVATION STONE WALL FENCE RETAINING WALL RAIL ROAD TRACK IY►AI, / / --..__..-.- STONE JETTY SWIMMING POOL #:�788 PORCH/DECK . � - j ❑ BUILDING/STRUCTUrZE DOCK/PIER/JETTY HYDRANT e VALVE O MANHOLE / \ O POST pF' FLAG POLE T O W N O F B A R N S T A 8 L E G E O G R A ► N 1 C 1 N F O R M A T 1 O N S Y S T E M S U N I T o SIGN 9 STOP.M DRAIN r PRINTED SCALE IN FEET *NOTE:This mop is on enlargement of a **NOTE The porch Tines are only graphic representations DATA SOURCES:Planimetria(man-made features)here interpreted from 1995 aerial photographs by The braes UTILITY POLE n TOWER w 1'=10D`sale map and may NOT med of property boundaries,they are rmi true lacmiaM and W.Sewall Company.Topography and vegetation were interpreted hom 1989 aerial photographs by GEOD 2.;t 0 15 50 Ndad Ma Accuracy Standards of this do rat represent awal rAtiomhips to phyval obieas Cofpororron. Hanimehiq topography,and vegetation were mopped to meet Natood Mop Amlrocy Standards 1 la=50 FEET* enlarged sac on the map. at o sale of 1'=Iff. Parcel lines were dig'ivad from 1999 Town of Barnstable Assessoi s tax mops. O LIGHT POLE o ELECTRIC BOX ..lsitemaps\Pub1icXm147p48.dgn Feb. 23, 2000 10:07:17 micPomcieap"" ;= VERTICAL GRID D . E . FILTERS Micro-Clear is a high-perform- ance ' , filter series that provides r` I ., superior water clarity, efficient flow and large cleaning capacity for d- pools of all types and sizes. '`' Molded of attractive, corrosion- proof DuralonTM, Micro-Clear filters 0 combine high technology features and "service- � w THE Poop ease" design for ETH flRN ^ SIUMMER MAL cHEM dependable oper- S SEA ation and low x. PUMP HEATER maintenance. 4, Plus, Micro-Clear filters.are avail- able with the unique SP-740DE n� Selecta-FIoTM control valve, the only filter control valve designed g specifically for D.E. filters. a For the quality conscious pool owner, Micro-Clear filters are an # unparalleled filtration value. _ 9 Micro-Clear DE-6000 with 2-position slide valve(left), a. and DE-4800 with SP-740DE Selecta-Flocm 4-position .-- m control valve(right). _ .� HAYWARD Hydrogen,Oxygen,and Hayward. The elements of clear water TM Mim- IearTM Vertical Grid D . E . Filters Automatic Air Relief purges any trapped air during filter operation. • Screenless design eliminates clogging. Integral Lift Handles and Uniform Low Profile Tank Base make removal of grid nest fast and simple. Heavy-Duty Filter Tank injection molded of high strength Duralon- T. for dependable,corrosion-free performance. �c= ' High Impact Grid Elements designed for up-flow filtration and y top-down backwashing for maximum efficiency. / Heavy-Duty Tamper-Proof Bolted Center Flange Clamp ' securely fastens tank top and bottom together.Allows quick access to all internal components without disturbing piping or connections. Union Locknuts make disassembly and reassembly of filter from piping fast and easy. �I Inlet Diffuser Elbow distributes flow of incoming unfiltered water - upward and evenly to all filter elements. Parabolic tank base design I provides for even distribution of D.E.to grids. -Size 172"Integ ral ral Drain provides fast, clean out and 9 d easier flushing of tank. Noryle Bulkhead Fittings for extra strength and heat resistance. Convenient Valve and Plumbing Options allow for customized control.2"internal piping and plumbing for maximum flow performance. r rD E.-Filters j FILTER TYPE: Vertical Grid Diatomite:24,36,48,60 sq.ft. , �1 • FILTER TANK: Injection molded DuralonT" FILTER ELEMENTS: Monofilament polypropylene cover fitted over 8 curved, high impact grids i CONTROL VALVE: 11/2"or 2"6-Position Vari-Flo,'""2"4-Position Selecta-Flolm 2"2-Position slide valve.May also be plumbed singularly or in series with quick-connect union couplings(less valve). PERFORMANCE RANGE: 1/2 TO 3 HP(30 to 120 GPM) 3 DIMENSIONS: DE-2400-31'/2" H x 23" W(800 mm x 584 mm) DE-3600-36'/2" H x 23"W(927 mm x 584 mm) DE-4800-42'/2" H x 23"W(1080 mm z 584 mm) DE-6000-48'/2" H x 23"W(1232 mm x 584 mm) Above dimensions are for filter only.Overall width with slide valve is 30"(762 mm); overall width with either 4-or 6-position multiport valve is 33'(838 mm). Data'Performance GO WITH THE FLOW.Unique SP-740DE Selecta-Flo'"4-position valve,with easy-to-use MODEL EFFECTIVE DESIGN TURNOVER(GALS.) lever action handle,lets you"dial"any of the NUMBER FILTRATION AREA FLOW RATE 8 Hr. 10 Hr. valve/filter functions—with a simple twist of the DE-2400 24 sq.ft. 48 GPM 23,040 28,800 wrist.Select from Filter,Waste,Backwash,or DE-3600 36 sq.ft. 72 GPM 34,560 43,200 exclusive Pool/Spa Boost positions.The latter posi- DE-4800 48 sq.ft. 96 GPM* 46,080 57,600 tion routes pump flow directly back to the pool or DE-6000 60 sq:ft., 120 GPM* 57,600 72,000 spa,by-passing the filter to provide extra power to spa jets or pool return fittings. "Determined by pump size and piping system hydraulics. 2'piping is recommended for flow rates of 90 GPM or more. Flow rates above 120 GPM are not usually required for residential pools. HAY WARD POOL PRODUCTS, INC. • M Hayward Pool Products,Inc. Hayward Pool Products,Inc. Hayward Pool Products Canada Hayward S.A. 900 Fairmount Avenue 2875 Pomona Boulevard' 2880 Plymouth Drive Zoning de Jumet Elizabeth,NJ 07207 Pomona,CA 91768 Oakville,Ontario L6H 5R4 B6040 Jumet,Belgium B-92 ©1992 Hayward Printed in U.S.A. Supep Pump HIGH - PERFORMANCE PUMP SERIES ■ Super Pump:high performance and quiet operation. Hayward's Super Pump is a series For super performance and safe, quiet of large capacity, high technology pumps operation, Super Pump sets a new that blend cost-efficient design with standard of excellence and value. And durable corrosion-proof construction. you know its { Designed for pools of all types and _ r A®® ._ quality through- 1 sizes, Super Pump features a large is out because "see-thru" strainer cover, ,� z. , its made by Hayward tally super-size debris basket To the first aywar n and exclusive "service- ease" design for extra choice of pool convenience. professionals. • HAYWARD® America's *I Pool Water Systems Super Pump° High Performance Pump Series Exclusive,Swing- Lexan®See-Thru All Components Heavy-Duty,High- ' Aside Hand Knobs Strainer Cover lets you Molded of Corrosion- Performance Motor . make strainer cover see when basket needs Proof PermaGlassXLTM' with air-flow ventilation for removal easy.No tools cleaning and eliminates for extra durability and quieter,cooler operation. required...no loose guesswork.Special self- long life. parts...no clamps. adjusting seal assures Heat Resistant,Industrial Mounting Base provides dependable sealing. Size Ceramic Seal. stable,stress-free support,plus L� I Long wearing,and 100% versatility for any installation drip proof.For fresh or salt requirement.Adapts 48 and 56 It _ water use. frame motors. I Super-Size Housing has extra air handling capacity to assure rapid priming. �• Totally Balanced, Service-Ease Design gives Corrosion-Proof No l® p P ry simple access to all internal arts. Impeller has smooth,wide Motor and entire drive.group openings to prevent fouling or assembly can be removed,with- clogging.Energy-efficient out disturbing pipe or mounting design produces more flow at connections,by disengaging just equivalent horsepower. four bolts. Model t 1 Motor1Dimension � , FIP KW • SP2600X5 /2 0.37 11/i 111/4' 286 N—a]H• L_INS J 3 I ae�l r numml I SP2605X7 /4 0.56 1 /i 11 5/e' 295 SP2607X10 1 0.75 11/2' 117/e' 302 Hamm SP261OX15 11/2 1.12 11/2' 121/4' 311 1 SP2615X20 2 1.49 2° 13/<° 337 r—a'mm� °win' I SP2621X25 21/2 1.86 2° 131/4' 349 , k' 11I�1-1 Super Pumps are also available with dual speed motors. ' m ft. 30 100 • 27 90 ' 24 80 21 70 18 60 s 21 SUPER-SIZE 110 CUBIC INCH BASKET has J 15 12 V, - extra leaf-holding capacity and extends time ix 12 40 15x2 between cleanings.Rigid construction with S 9 30 (2 HP-1.49 load-extender ribbing assures free flowing oper- 20 ation for heavy debris loads. 6 61oX1 S 3 10 x s x,o nv,H -,.,z Su er Pum ®Series Pumps are listed b : v..P-o. Kw s x7 P P P Y 0 0 1 /4 HP- .56KW 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 GPM c 0 38 76 114 151 189 227 265 303 341 379 416 454 492 530 LPM NSF® s CAPACITY PER MINUTE OO • HAYWARD® America's "I Pool Water Systems 2e93 1-888-HAYWARD www.haywardnet.com ©2000 Hayward Pool Products,Inc. 1 �ZN OF MRS s cn nn"ovod ` 3 "71Poi0THY O % N!ALKER v. Aanu13c7:nc-'= •r.. CIVIL 33' J o 'ITf:o. 31 �6 RADIUS F ,..� -.- COPING LAYOUT 9 9'RAD 'RAo /3// 33%1'{r Aff'.nrruro..er- I lIYIJ 4.6-RAD 1 W 1 6/ �` yRAO q RAO / � 39'7 PANELLAYOUT 3•yw dR.0 A•�n X T 1 � • --�a—S 6' y'6 -6—�i ' I, y z 12W'229'PANEL(YYP•) b � - Ya.c X-BRACE , XT. rEz AAa aOAR —s'--k--e'—•k--e'—+—e•>. DE'fA0.A a.ovat-Po w top Pod Pool tr..aaonu. Area Capaciy "' o.mwmi wmue 6 6 5 231200 tr G a.lf.ne" Sq'FL Gallons maw.ur. wet a+n INVWAM a uasrta.Imt.Pon THIS BROCHURE IS FOR ILLUSTRATIVE PURPOSES ONLY �f T"man.Aadve+makes Only W�representaporn stied,we stated M Ra.nlna,vrar.anty.Any pdmr ��/litO' ROMAN EDITION POOLS rmps[ tatkx%xstalerr.entf•a e &r Cts made by Rn deals wWa the con&actor to do CusW merarymatertata produced Dy Un mar..dadva are aMDutable to 0f doter wW/ the o On r cma"Poor" ta.W.rr n e dealcv aoo R—A ..a oeeaa o`""'"';On IW ban bmfed a ent ooneador and ap an rm..on.n END —IPIoyes d d.e manutadu.er.The aor.sWcton metMdf alwtnla0 en auppnfllona and apply 0*b normal pond"dim TTae may be addnronal precaudorn and/or medgda of tar WUCOon r ono u.toua ra•.ta•t.a_Tf•e reMmo aaity Is d.e contractor, / rx� 6" RADIUS CORNERS .etaf MVI-M etwa S' RA__ DRis rOPN as SCALE: NONE 1991 RC r ^ ORDER NO. SALES AGREEMENT FULLY INSURiED & BONDED DATE l iENCECQ 0 133 UPPER COUNTY ROAD•SOUTH DENNIS,MA 02660•(508)394-4800•FAX(508)394-6735 IfC O1R IP O RRJJA T E D• 05 WOBURN STREET•WILMINGTON,MA 01887•(781)933-1234•(978)657-5410 FAX:(978)658-9932 NAME /�, SHIPTO STREET STREET AV CITY STATE ZIP CODE CITY (( STATE ZIPCODE INSTALLATION HOMEPHONE BUSI f55� TELEPHONE �'�j� �/ �7 / �/Y NOTIFICATION STYLE NO. RAILS HEIGHT ft. ON YOUR PROPERTY IN ACCORDANCE WITH QUANTITIES AND LAYOUT SHOWN BELOW QUANTITY DESCRIPTION UNIT TOTAL r G .T� DEPOSIT TOTAL SALE IIALANCE On Completion TAX TERMS TOTAL ONE HALF WITH ORDER BALANCE ON COMPLETION LAYOUT-INDICATE ON LAYOUT PICKET FACING ON EACH LINE OF FENCE. CHECK LIST CLEAR FENCE LINE TREE/STUMPS IN FENCE LINE TAKE DOWN EXISTING FENCE STACK BUILD SECTIONS ONJOB TOP OF FENCE TO FOLLOW GROUND RACK SECTIONS STEP SECTIONS G•� CURVE SECTIONS FACE FINISH SIDE BARB TOP- KNUCKLE TOP UNDERGROUND PIPES OR CABLES BRING COMPRESSOR GATE SCALLOPED GATE STRAIGHT ERECTING CONDITIONS GALVANIZED OR VINYL TAKE AWAY OLD FENCE All quotations subject to conditions beyond our control.CUSTOMER IS RESPONSIBLE FOR establishing property lines and fence lines,and for conforming with local zoning by-laws.Pro Fence Co., Inc.,is not responsible for damage to underground utilities,septic systems,drain pipes,or propane lines,unless notified in writing by the Customer as to their location,before work is started.This quotation does not include costs met in extraordinary conditions-striking ledge which may require the cementing of posts or the use of a compressor for drilling and pinning posts,or clearing trees, brush or other obstructions from the working area.This contract embodies the entire understanding between parties,and there are no verbal agreements or representations in connection therewith. All fence materials remain the property of Pro Fence Co.,Inc.,until final payment has been made.By signing this agreement the customer gives Pro Fence Co.,Inc.,permission to enter the property and reffidve-aV Mll fepc_e materials if final payment is not received. BY ACCEPTED BY On accounts over 30 days mince charges are computed at a periodic rate of 11A per month-Annual rate at 18%-'Plus any additional costs incurred for collection;including reasonable Attorneys fees. i p �, ar i•• rTp t�,l � r �ro. ^S n h'e i.. Jc♦ �r y'• 7ti .x"�»+�a+. m �t� ,Ed is 7-.>�'" c�i.�^ �R. . � ���eve��'.�j�a�+•--- t � -` �J t'� ,._ _1R"u.L 1 k. r ,�e�„1,[\,>1lx- e< ,yy �9 r r l.. ... �:� 'NIA. � Y,i� •e.Yr� kr 4 ! ..+ iI$ ,� s i i 3 •ate r��a��4'e�%c�,A:•'a...��:::e�? f i^' �s,�:,�K •( e`s h.�"2'r=� _ i •i n u uu u i f nu 17 Ilk ,�4'� 111illiililililli 1 1 1 1 "� �t• a ��� �. ���������v��a•�a• Ali ��� ,R1r fafw�^Oq@�P.w rti,•7 "U "'T-•r-• n��u 1 1 1 1 - 1 1 • 1 1. hr<9E1(?{, 4G 7h�t y�13 6•u� r ij r� Mfg. xh �j �,�pp f•�t� - '1 1 1 ' 1 -1 1 • 1 • l ,p a � �o�>` •��d acre ..ram �.t'�t��• �� Vp ��• .'�/1� � ! 1 71 t . � ��4! '��f t i-�,'�'..a �� x tAd ,.���F`t'�' F \4' �• a..o•D' �I �i�N�j� ♦ �'� �� I ..S1C..' r; � �:,�{,.1�', ,... ..may ! t ..�„���v,h� �x • ,�' 71 G � �•" {�•,,.� S �7.a r '`N`,�_."wif.p k, "'�,�' ��i��� .'Jt f � � �{'q' t. .�� .�,H rn ,'.,b`�,.,1✓ -f�'ti.rxo i i�-•,�`: �.f�'y ^`}" �^u,,,y���}d S $�vl�,•�l".p - 528..� ''�c �ti t(µ''d`L tri•�-'�'_ .': V R h •"�., �.8 '® - .' 6 �' � r 1. �.-� ,� + y,`' _NOTE: BECAUSE SUPERVI! PkOV!DED. THE STRl;c;; .., l- AT !;'. THE Rf REGUL A 1 IL1+v] 1N THc. C.0 OF THIS SUILUING 3-0�?irr/-RAitl.� • .S�/HOLE '4 ^.s�ACE 5V Sa . o l ,5 TA/RS .¢- /O � 243/0 lv/06/R u �� aA ` IVO 7E i 3 _� _!__........... . . ,V072- Oc RID a"m 1/25"/ r W � x /4 /_,q/N, a t ir-a/p W-0- 1 lW1TH -41X /Z! e 8 / ,BooKS ,SooKS V I0� ��: _ W � `� � ".�. ' �t�w SF9T� io' � •Q � �; _ !t/.41.4C Gt r ;, I I /FZ OD R !///V Z.- A9REi4 _NOTE: BECAUSE SUPERVISiUN Nut PROVIDED, THE DESISINF R ASSCMES NO RE ''':.%^,:.':: ,.. ,Y FOR THE C�-N - SrFtI THE t2E +;' LITr REGULA11UNS IN THE. OF THIS SUIIUING _ I ^ 3 -� I 4- /p - _ I 2 431 o I I ��7E N IAI ' I AF119I v (204,11 lle S=DAIZ) jP=L fi/ L./v/ivG r9REi4 : 8 2 .55 S. F: SHf'E T /V "COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY OF loj�COM40NWEALTH�AVE. MASSACH BOSTON,MASS,'02215 l I ENCLOSE CHECK OR MONEY ORDER L I C'E N S.E EXPIRATION DATE CONSTR. SUPERVISOR FOR REQUIRED FEE, 06,130/1993� 04 RESTRICTIONS 5 EFFECTIVE DATE LIC NO. d MADE PAYABLE TO NONE = 06/30/1991 010219 . 6 "COMMISSIONER OF PUBLIC SAFETY" T RANDA-LL G -SNETISH (DO NOT SEND CASH). SS �/ 377-46-6982 10 WHEELER RD pp &A MARSTONS MILLS MA 0264P EAVE N0 PHOTO(BLASTING OPR ONLY)_ FEE: F E I N�A S E 100. 00 E 4FECTI �E4FE�. 1cjc�I :1989 I HEIGHT; NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY STAMPED-OR-SIGNATURE OF THE COMMISSIONER DOB: 02/13/1947 . �� n_ . �N .11 NoATA14H ttI i - - -x THIS DOCUMENT MUST BE S E STUB CARRIED ON THE PERSON OF SEE « SIGN NAME IN FULL-ABOVE SIGNATURE LINE OTHERS-RIGHT THUMB PRWT THE MOLDER WHEN ENGAQ EO IN THIS OCCUPATION, , 20OM-2-87.81429 COMMISSII ER O � �ln a✓��.�.ea CrIL. I Assessor's 91fice(1s%Floor): rJ 0 �/ p 0 Assessor's map and Cot number `7`a o�TM E to Conservation o�— SEPTIC SySTEJ� Board of Health(3r floor): :INSTALLED IN C©M Sewage Permit number 7 rY• Engineering Department•(3rd floor): WI TT �° i°��6. House number' ."IRO MENTAL C NMI? ,:Crv ! 'N� a Definitive Plan Approved by Planning Board 19 - . ,GULATIDNS APPLICATIONS PROCESSED 8:30-9.30 A.M.and 1:00-2-00 P.M.only TOWN OF BARNSTABLE BUILDING AN.SPECTOR APPLICATION FOR PERMIT TO � G� ��z%�LG�- LAX I�S�LiCJ �&44,Z TYPE OF CONSTRUCTION &)&O j �I V6L-X CLAA� �— 19 < Z- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ono y?� Proposed Use 61,'L Zoning District Fire District e U Name of Owner Address o14 �lZ 44� Name of Builder �2L �1 �LZt2_'/Z� Address Ld GCS" 2X,a&IL4 Name of Architect /J�% ��Gc�t� Address 8 �� Number of Rooms �C-� ��d-�L_� Foundation e llrlt Exterior Roofing Floors Interior Heating 6 i/0'42� Plumbing Fireplace Approximate Cost b �Area 22(1 O,- Diagram of Lot and Building with Dimensions Fee /l S;7S 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 Construction Supervisor's License I '.GRAM, JAMES No 34982 Permit For BUILD ADDITION Single Family Dwelling hcation• 26 Weathervane Way Marstons Mills Owner'" -James` Ingram Type of Construction Frame Plot Lot Permit-Granted April 22, 19 92 Date of Inspection 1�` '1(114- 19 Date Completed J/7� 19 T.' y :s14 ' • Z, 1;. t; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel d LfF Permit# Health Division Date Issued Conservation Division Fee Tax Collector e G �pliswi �, e ITreasurers to 11 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address C �G Y `' kC4 � C4 VV a Village 1 I C4 95 JU0`S 1rn r I�)S . MA Owner ►( /LQI Address ��G1Vl�Q GIS Ct�'JC)✓P Telephone = I t Permit Request i C Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation 500 C) Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: Cl Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ® Two Family Cl Multi-Family(#units) Age of Existing Structure S Historic House: ❑Yes UN0 On Old King's Highway: ❑Yes ❑ No Basement Type: Cf/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 ��Otal Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: O G ❑Oil ❑ Electric ❑Other Central Air: ❑Yes Q No Fireplaces: Existing New Existin 9 'Yes ❑wood/coal stove: No Detached garage:❑existing ❑new size Pool: existing ❑new size I� 3 Barn:❑existing ❑new size Attached garage:C(existing ❑new size Shed:2/existing ❑new size - IZZ Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded El Commercial ❑Yes �No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name G/�Lcl �' CoB Telephone Number Address aOO ►`1 2c_41j r V76J)�\_a License# /r Home Improvement Contractor# �U Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE n FOR OFFICIAL USE ONLY -PERMIIT'NO. DATE-ISSUED MAP/PARCEL NO. 9 ADDRESS VILLAGE a s OWNER - DATE OF INSPECTION: s FOUNDATION x. FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. _ The CommonweaUft o maysacnusella — Department of In&atrial Accents _- 600 Washington Sheet . Boston,Mass 02111 : ` Workers' Com ensation Insurance Affidavit % tar irraia aaa alit M���� name Ch Q2 I + LI7l,I22 �O✓L-� to�ation 2 a \A-)_C__C, city je,SdD/ `'S [, hone 1! - •6�� am a homeowner performing all work myself; ❑ I am a sole roorietor and have no one is am //� workers, serration for my ploy on this job. over � an P� ................... .............v.....nm+}avrk4v{..rz?t::..i. .}......,. ::.s•?'::.::. ... ..... ... ... .... ...... .:v�......n.::.�:•r:{.}:{<:.}'^+i?: :{;:<3:i::L:?:•i?f:.j:-fr:i`i::�':J??}?:•Y:;•?}:::::::�:�:::.:. ........,............................ ......... ........... .....t ,.......t:-.,' nw:^v::::::::.rY',}t ............::n?Y:J?:.:'.:: v::::....................:::::::::::::................ ......:::::::::::.t::n??}:•i::...:.v.}?A'•.4:?n}?':nw:. ::.:.v•.v:v..... .}.}•:.:v.::...... .... e:•r::::::".;;:::is;ri:.}:;:::;.;;.}}:;.:;.i;::.: ............. ...::..�. ...............<.;.:..;-:}.??r;;::;;�::..::"?•:•?::•i::z{>;r::43:.:;>.<i?�:::;;::::::;r::i:?;:;�::%:<;:;::>�::>::::i::»»>::t:?:;Y. .cam BnY nflm .... .... ......................::..:.....::. .....tn..,,.k�:.,«{,J?a:f: .. rytr.-,.�,ff.:f.<....:.:.:::.;.:i:.Yx::.:,•.,r:::..,:.....:.. ...... ........... ........r.............. :..,a.......t..... :........ .... b ycty. .. .... .......... .......... N..^.. .n.. w;.:.....-+.:..::r-: r./. .... .:::::::rvnir;:.,.v.v.n+ :::l�ii:<;:::y:ii?.}•::.. ............ ......... ........... ..............rr... ..............,......:: ., :a• ...•.Y'., .. ... .... r.•:;i�ci:�it•�:Y:�•:::•:ii:;%%.�::,.,�. .........:::.......:.:::..........::v..........•:•v::::n.................. .::r .:..n...n..n... t. ..fit•�:�.{.�.K , 4 L... ,.....� tn.........:....:.+ ....., .............::::::...:.:::::::::...t::::•::::::.:....:.::::�:........::::::•... .,...., ...... t{, H.w�Ox}r�( .. .Sf" «t�`'�' .:.......y.,.,�:i;.;rrii;::::;;••?-:•::::r:.i�{::::::•:�... .................... .w::............}....:^.....:.r.•:vw.v-v:riv:�r:...4:v::!-.�w::'^ �`3,.:J q}x�l{.�C..e,t{ -K- J;::.,rvY' .., ... ......:.:: ..�:.:{..}:.::.....:u" •s-?}': r '.:,ny}}i:;;•xu;:::f}}:'':.i:Sri}fireyx;::;:<r:i;::4Y< .. .. .:..........:.:::::...........:ern.. .:::r...}.;nM:•,- ... L....:• � l..t .;}y:...,.}.'?'?•-3:-:-i:•Yr:}:;is�r':-<::;::::�.:..:..:-:;:%:�::<';::;>`':'{:::.:'::::::•;:.:.r:':.. .....:......:::.:::::::::.:.....::::::•::n•:.::::.�:•:........•}r^r..rt+:`x, :nn:.:..t J�.S„ St,Y„t . . .2` ...^L t L^'.t.. ' ..../ , . •4t}::.::.:..:}:::r.t..::;,:.4;:it.i.:.i:.::S'ri.;:::.:;'-:•::r:- ...:......:....:::::....:.:::��::.........:::::::::::......r...........::::r:::ni:•.............:...Rt::-.�:. ••r.......t.wC,'f¢t•. �• !.:/.n.. ''.-.' .. .. r.'>fb, .........,:.........................:.......................:.::..................:. ...... ..:..:.:•:., .r .t, ..-era:..:;;:4t,t�:�:c::.%%::;::;:c:�i:`2':�. ::.;:.........................•.::::':::::'::::::i:::::.:::::.•:.:......:.....:.....w.r:--{:.r:;•r:':•,•: vft,'-.,:..<..:,.3Yt...i ::...:..::::.... ... ..............:.........:.. ... ..v.vn :.J'..�v�'(yri<.-?.....:... ...:�:.:.:w::n::�.�n': :..\va::J?.:};hJ•ii"i; k:}::;i:;:j:�y:?r:Yiii:::-.. .... .......................... .......::...... ......n.:.........:....,,}'a[.::..,• ...... ��C..: n}:. .. "•Z"l'N.4Ek:+4!" "J,.•ir.;.}r;}.,.i:...'•:.:::...... .. .. ........ ............ ............ \.,tn...n..r n.. ... .T. ..}.•i .r,.r •n..:.::'w"v?:::.:<;J::\"�}':;�\<i`��:v!::::::::: ........ .. ....... ........ ......... ...x... ...... ...,H .t.. .. .f{: `:n..lit/(.i i."i 2:..A'' r:...::x::....:..v..-:.,...;.:•:3::•::v:::n:_i.r ........:::........::.:...........::::.......r....:::::::•......................... ... rr....t...:.e...: nt a!M!^:4...i.. , n:{,"ix{'. ... ........................ .............::..................r..::{:..................:..:.r.r.........t........ .fi.-..::. ..}}:.it•::::.,,n. .,t.:..tr..Y•}.t'J,:.u;.fC"i�Cij�ti:.:•:;•r -.:.}:•,.- ..... ...........::::::::::::::.Y:-?:•is4:•r:4:�}:-?:;;:i::'i::::�i:�i:-?:-:4::.... ..... - � .........::.... ..Lr• t. .:..v::........... ..........•...........::..........:v............-.:•:•rr::n.........vht.v::4?ri}?::.:i:'4Y:?'<v:^.trr?.tr,.•..:::.n:.-:•..:. :/:: ...:..::: / ❑ I listed below who am a sole proprietor,general contractor,or homeowner one)and have hired the exactors havethfoliow...........w.:•.o..r..k...e......'...cmp.e....n......s....a..•.•t.-l.-.-o ::^O.....h.......t.ce............s...,.:........r.....}.:...v.�._...v.:,t-.-..}...m.r..w...r..........,.:..::.:...::{a..:.{.{at..t..4...:...:{4:.:•...?e.....r...{.�..x....J..........}t,Y'.i.}.,:..,.n...,.....{..nr.t<.t':.,•.'.r..K.a...J..m.Y:.J....,.n^..'..,..v.r....v.........-..W....nw.^:::J-..v :-<{:.n;:,n:t.v{;y:..v:q:::::.4 n'?:vti<S:.^:::n6::;a^.vr•,.::.n}n,±:..+;,,:3.•..}-}:'.:..:.h�.?W:r.::..}::;-:b.::.>:::.:..+,Y;...r ...............:.......................... .......................... ..}'�n...4nv..•. .....: .r ....}......$...... ,.....r............. .. ,4i'?vyvi:v{:itff:>:i:::r:::': ............::::..........:::.............::::.:n................v::::::...................:...v :n_ {.......:•:.:.... ..n^..• 4:.. J r.,.::.,.. ... :,}yn vnv^wn:........•: :i}ti ri?xv4 nw:::n,. .... ... ....................:nv::::::::^........•:w:::::::::::.n.. , ...... .w:::•.n.::tr3.4?ir.....::: .{v' ;...r vn{W:x•.t,..v. ....,......-.. v. .. ...iv.?:-i-?':• ,:... }.........n..v.v:w:{itf:{+{�{:x.:: ........... .......... ............. ............... ................... ............... .............. ..-::::::::,..r:. �..:.n.. :. ....fit.... .....:r._:::.- .....:.: .................................................................... .t...... ..:::::::�::•-:. ...... ' ...:axis .. .. w-.a:•:.t.}ii•.:•:?'':�';L:.;�;.;•::�i•: ...................................... .........n..•:•:::w.....n..•-vx. ::::.t......:::e, ... }.4. v:x-.4.•. /{' tfi( ..../.vn.n:n4.v.v::: ........................................::::<:.........................................n..:::::::::::.:.. ..... .:..r. ,. ..}.,-.•.. .a......... ..}b}..:.,...t:�.5......r.........?.......:;..: ............:..........................:................:..:.....a...........:.................^..,...... .,..,...L.4a�-:.R,-.4:,,r.ar'r:::n::•.:::?r:.?:.3{..... ..... ....................... ..:......:.... ...:...................... msnvname:. .............. , :..:.......::::;.i"Ws;J'.?.:.• . ..ws�L�.: .:�;/: .:...::....t:.:.,.J:;::••:?:-.;:;::.<::.,r:::;•:.,::>:;::}::.}:::�::•i::: .i::-.i'-:i:}:ii:•n.::-r:.:4x-?: tr:n•-r: .'<bxoav .,+:f::•.,•. .¢�. , ..: .'40?{ .... ...... .........v.n ... ... {.� x :.}}. }• •.v.-.., ti5 i'i4}• n^...rx::•.::ra n,.:�v} .... .............. ..........:::.n...nn:::•........ ..n...:::::}.^e.rC .. ....}ta,'J'a:.... .... J:. rNv.{....� � '� :}..r ...fi>.S?} ........................v.r................n-:r............w.t:.. ..$..-......:::::, .4�.. ...N--....4n ,� .:•{/ .4•}T•. n`Y.t`}' as .v r{.}}.%i„N4. ��t;:viS3R�..�:v.v; �ir?:4}?r::w::::x:nr::;.n:nv:•............. w.vr....::r:-r}....t ..- ::a;;';!•Yiv ron t .�' ,�- .,..:::::::::::::.?:•ir:•::;it:;;�'%"?:'??:"??::....... ...... :......:;. n:-....:.....bYin:•;":r..tra",.t. ,}'.• 3 -:::•.....-v:nvn....:w::n•.........................r.......4n x::::::;::-?r?}... '� xn-:.h•\-..v -�y. ......n..•.........................:::nv:v:w:::^?v:w::r:•vw:::::n...q}:•Y}i:^!-x• :YY?:{'•ir::;;•Y. •.4i' wr Ltt: 'ram f{.?x:� L4P5 6:'t•x4:Y.J33{:L�t+�,v,:.}":ivt'..b-i. arYC.w::::Y.:::. ,...:::::::....:::..:.:::. ...:...+...... .,.....::..,........:::.,..a.,;{... .,.,.. .:.. .L�Yo:b�:'•+?`itk'r.'F.•{!?Y':d9.72if:f»':.,�r.'cfa+ •..r....::�::.....::::::,;.?{•.:}:4i:Y:;t•:::•:::..?:;•:.;.,.r.....:a-.�•;-?:-i:•}n�n,•r,.:.. ::::r:Lt•}.Lt?:•:xLt<tr4t.��.yO9}o. dr/.... • :t1� .... 1 ..... :�„:.:r:'':9tyorix•. ':iti+ax+?�^�;�a{y{cyaK4, r.N>•�:'%•::^;::i<:�i% ;::::3;. ..:......:......�.....;{:�•rrn..Ht4'w::";i-;,..4^y%oY:<.a:.t•. ...... _.........•::;oa.........;..:........... ...........••.......:- .+.:..•. n.J .. - � .,Vj.4r`J:y.;,�,�.',...�"'ai;?f?%if>.n}}(.�.,4:::::::ib';t�,...,,t:...;:,a_jc::i:r:; .....::::•..r...:,•::x...vi•.,:.::.,:...b}{..:.:.:.k;..»::::{.;,L.' v}:y. ':.:- {S ,x{}yt4t - •: .:.x. ...,r.,x...... n � ,t•� v.'a'{r:;`;:.a :w+\iFw`q�:�:,;°d:�•" f: :�:�#:Y:%�:�: rH::r:::r:.:'•::.:.?x::.?::;:,•:....... ,•i.:::{.�:. t.a�'..tGn e v:, •:r:. .a ., .... t�'f:•:J..�-t.^{'ab4..f.C+?;:;:.Y+Pr`.�3? .......:::::r::...•:.::•:..:::•:::.�:}:;?:as:;;•:?:;;:.::::..nJ•.a:;iy4:}4+ir•av).:'::.G:^�.:.+;. � - �,.. '' ��y .. . . ....... ,....:�:::::::: .:::.4.t:tr:.:•::?`i x•::i:..,.,,..:.. .x,a}~~.....,,�c•'.�2:..A � ..a.Vh• ...:.:.: � :{-,rx^'^';•r;•:::::.::. ............... .:.:::•.�:.:::............... ...... r .. ,vr..n,•n.;.rw.;r< �:'<'atiY ::Vic: ..........::::::::::-::::::::.;.;}i:;-rw:-}:"y+,:iv`:;}• trx.??.•,`',+wx4•i!.;:ac':?:;.;r}.. -••.< .Y'{''�'3't'�",'4'{4•:``.JiGa .,.4•.. .,.{.. \.a ::.Jc,.t,-T•}. •',a+n-.:}:'c4g nL ......... . `.......::............ ::::.;;.,......,..,-r.}:•ri?::::........::{...K{,.ptwr• .bt.-yt ., ...:.:n.....�:::�?:t-:•>:-:a}.•{.i:;%�:i••}?:•i:^•ni:?:::rir•.};;.,::-::-}iY:•:.:.::... n}:::t:}':fig{;},;.µ .. ..-. .-.. '.-. �p :Hnfff}ifii'rii::{•?'.v:::::m-.,v.,y,,/,r{: ;:xrn: 4 : '.•....... }iGrvr}-.. .AC<{'C. :..!a....::::r:•v:,.::v•.•' r::: n:i.,- wen; \,,,a.t... •w::::......n....:..:::«Criir'v..-v£»yr\yMrr�ti)'•b.},4. v.-.^..5...'lvxnb:4wL<.�J�• .Q�,.v-.-'}' •�.: x • timrsncE?ca:>:::>::::»>;:<•:ttr:...... .... ....::�:.:.. :�:�:.::::.. ..-•. R.,, n x.-::'ri:t<j<nAYL.y{}:.;J..}a :L.4:, :ii:�::v. :.................. ::n�::::::::-v::::::,-:v.y.;;}}•{:4:... ��p -,Jn.,}C:.--..<:..-..4:.v'.:;C!aj:.i'i:;::i??:rr:<•ii??ir: ..............:..... ...... ...........:.}}:::v:.v:.,..r .:}.::::Y ...Cx'+A'.Tr}FY-0ES} J S.;:F• ..: .. }-. ,�},� ..... ......... ................:::v::::::...':::<;'....n......• ....{.r.,.. .a...ntrU' .. - ;%vK'ifn:$,,^v.}��iYtr`�?:'w�:v?.b\.xjh4;Li.��i�:':;:•t:::<ii:ii ... ......... ...............::::.::::::............::•:•:::::-:•::::�-.;-:.••.ter.-:::,� -: .. :. .o.. ..�. B„f:•:. •..{. ,n:Y<"'� ..LS''r..y� .......::::.........::.........._::............::::.................:.:::.:}...,.t.....t,n...n+.:..rt.........a.,2 ..a ..... .J.J - •.t... a•L•: :?,;i;;;o'$:-5iv+y•• . ::,:•:..:.:::::.::..::::::.:............r::::..:.::::::.t-:::::::.t:........................11,..,•::::••::.{:: a k %.: ¢:;k?}.'Woe?i::::i.v .,............:.v:.v:...•::.......r.....::•:::::::•:::n:• ...... ......... ..:..,-::::.,.r:.rv:::-........ 4 Rx•:vvt. ...... .r ...........v........ ....v::::-:...... :vn4v::::::v.v: .?}:now:.: wvr'.�1 i•,,•'- , ......v:....... - ............... f - :,:.........-- v::::::...•:Nh:•.v.,4'.r.w:.v::::}:n::4r:::}:-..........:..'N'...v�. ... ..:::nn......... .... ......................iir:}...r, y.�-.. ?....:•.';. ft.ri,'^•::iIX•:-:�, :..........::........:. ..:::-:.w:::n:v:- .::,....4 , L'aJ't.{r{a:... ''..., .. .. .,.. .-..S}•xh..Y:hsT}i:{�W:�Gfr\'::3wnvn.,::^';'rr"_'?ii:?w:::iii .............::.v:::....v::::::::.::::::::::::::•-::-:i:{•`:::n`:.,•::::.,•:::>{:-:.4.,-:i.v•-. ..c?,.!}..�.�.Q.::'4- .{.}- 2tit\?.-.�/,-.rhtJ. /<liYt,.L?..,.,..:.Y.t�W..,:-.::::n:{:.:.err ..........:.... ..,.,n.,:n .. ..+C r....... t-:: .. .;,,r. t:r:i•:.,, -:.?.;+::; ic:' '::::;:i :i;: ...:n:•::::::.:•::;:::.v:--w:::;v^....-.;..:v- :.n•4vv.:v:::::::.v:::•t••...:n..........v.. ..v::::r;K^'3 r�>�i.}.v:n:. -- :............. .................:......t.....4r...:............................ ............{.v.. :i4n ii•:::.:J?.......r••.. f;{:.:n...:err.• ....Jn.. /�. v1F4:{ f ............ .....:•::::. ..................... ....}:4Y•r>Y?+rYi}r:•ii•..n:err}:r<..v:::-.•:.,4�na. ?-.b. ......::::.�::::::.?Yrr:.. ...... ... ............::::::::.:: ....}::::::::.v:.v<{x.....:-::.v........:it?.w::.vrr.{Y.•!:t•3.?r: .i}::::.......:::.::............ -:.::.:v::�w::::•:.::::::n:v.v:::::is::::......:::::::•..............: ... .::i::::::r;.....:•:r.:v:::..v:::::.: .. ....::.v.... •n-{ :4:;•:h W-'!;:0:•i,;•ii;::i33Y7?:'• atidree .:�:..::......:....::v":vv::::nvv:};m•;}};::r...<•.!vr:::.::+•.iff+•.Y,...::3,4 .. .... .. .v.{a}}r:4}:fri::•:n.::n••+ .. ....................... n...................^...n............{.. ....:,r.::...........f.:.. ..}t.a �4 ,M...rr .... .......... ............. ... ............... .... ....... ......r...... ittx f,....... ^w4:•r?:4i:4:J:tr::;:yii::n+':<b}?i::.i:r?i:is i}:'i:':::�. .. ... .. ........... ................ ......................... .....}n ....,....v:,.•n:?:w:::: ::•,tr tr'.%0..trT,::?.tr::::.v w:::v.,•:4r...::::+.•:::: ...... ...... ....... ........ ............. ... .......... .../.:... �{ ..... :.:..a...v}.;/..,,v..•n}:\::n}xxy.{r:.rv..;J}+:�::•.y:}{:i}:{:::...., :.::n.........•:n........•::n...........:n..........:•v::::n:...................:::::n,....t:...,:tiz•. ....Hv:,w,::J•:wfi. x+v%LitrS: ...e'J..-....eS,:r. .............:n........v:..........•:::: ..........:::................... ..........:.}:}:t::•..+...Jn..r...tn4r .{ ....:: ......r... a ::. .._. .........::n.........:n........v:n... ....::. ..............+v::::nv..:................+ ...v, .,..: _ ..::.............. ........................... .... ................::. ..., n.. .................. ...... ..... yt4•:xn-rix(}:ryi:;:}:ii:;;;;tit{ii<:i!ttw.:;4??.}?:tivXrvn4�::.....; .. ..:: ......... ........... .................. ......-....... :,..~....,..... ..a�i ..-.: .,..- ........ ......................... .........................................[..........:......., .-. :c. .L n3�..;-rrrS.sn '^4wx:;.isa-i•;?4•::;:•:".`;:::�:?;`':aft%ci:�::;;:::�:r'."'a> ::.{•:n-.vv:.•:.v,..v.Lt2k- .Yl.�..:x ��� ,vtY...M.CC:{{{'r. ;r x;;?{:{::Y,...S.:,... :n\,v:n,v'f.'•`�J\v:�::Y:yt{':2rii:2�`ii:::�.. ..........::v:::::::n?}?:•i:t{•??:4::`v:•:::v::.v::tr:nv:::::::::::m...••.w:::�:{•?itC:;-r?r:•w::::.w.t:•:f.Y}•...... ..•-{:.:. .......................................:.....,..,n.......:-:::....:::•:-:.�:-::::�::-:;;;•.....:.nr..e.r.:.{,-.t4. ...... ,tr; '.., w :.rxa ; .;....,n....vn{<:`:•x: : ::� . ......... Fan,ore to secure coverage as required order Seedion 2SA of Al 1412 sauteed to this imposstlan oferfaial pemltle of a fore erg to S1,00.0o and/or, a one years'imprisot®tat as wed dull penalties is the form of a STOP WORK ORDER Bud a Qua of S100.00 a day agdmt me. I tmdersttmd that copy of this statement may be forwarded to the Once of Iavati�lans of fhe DIA for eovaaie v en'rtndcr the mid7r of papwy provided above it&w.and coned 1 do hereby a fy P P . Date Id '/�•y� • SigttatuxL L l Z � ,A ) �'d� � C� Print name ofncw use only do not write in this area to be completed by city or town ofndal # ' �By�jag pepaetraeat city or town: PMWALC.M OUcensing Bo'rd ❑Sdecancws OIIIce ❑che&if fmmedlate response is requited ❑Health Deparun-t Pie fi3 contact person: ❑Other (levueo 9/95 PIA) I Information and Instructions l Massachusetts General Laws chapter 152 section 25 requires employers to P resideworkers' compensation for their anv�� employees. As quoted from the"law",an employee is defined as every person in the service of another under of hire, express or implied, oral or written. oration or other legal entity,or any two or more of An employer is defined as an individual partnership,association,coif of a deceased employer, or the receiver or the foregoing engaged in a joint enterprise,and including the legal rePzes to ees. However the owner of a trustee of an individual,partnership,association or other legal entity,employing oectupamt of the dwelling house of dwelling house having not more than three apartments and who resides therm, house or or persons to do maintenance,construction ar repair wo&on such dwelling another who employs building appurtenant thereto shall not because of such employment be de=ed to be as employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewer construct buildings in the commonwealth.for any applicant who has of a license or perrnit to operate a business or to not produced acceptable evidence of compliance with the insurance coverage required. Addttzo�y,�� commonwealth nor any of its political subdivisions shall eater into any camdraet for the performance of public work until acceptable evidence of compliance with the insurance regaitzUIEnts of this chapter have been presented to the contra=n? authority ngwm Applicants compensation affidavit completeiy,by checlattg the.box that applies to your and Please fill in the workers' camp a cestzricate rof insurance as all affidavits may be y.�ly�company names,address and phone numbers along Also be son a to sign and submitted to the Department of Industrial Accidents for 00�0r aft coverage. or to application for the permit or license is date the affidavit The affidavit should be returned to the��y�eve n;gardmg the"Ines"or if you being requested,not the Depariaueat of Industrial Accidents. at the mmber listed below, are required to obtain a workers'compensation policy,Please calt'the D City or Towns _ .. _. .... . l The Department has provided a space at the bottom of the Please be sure that the affidavit is complete and printed y contact the applicant. please affidavit for you to fill out in the event the Office of Imp be io be sure to fill in the P=h icense number which will be used a � s a a number. ,the off day may hR the Department by mail or FAX unless other anang�s have been made. The Office of Investigations would bike to thank you in advance for you coop atian and should you have any gzstons- please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Me of IWesmadons 600 Washington street Boston,Ma 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406,409 or 375 • �°p 1ME T°�� The Town of Barnstable • &UtNSrABLX_ 9 �• g Regulatory Services g'A i639' 0 1►v Thomas F. Geiler, Director, rF MP{ Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Fax: 508-790-6230 Office: 508-862-4038 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:_ Estimated Cost? 0 d . Address of Work: / V Owner's Name: I C Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 ❑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 IMPROVEMENTWORK-DO FUND UNDER MGL cE. 142a. ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. R Date Owner's Name, q:forms:A ffidav:re v-070601 r RESIDENTIAL BUILDING PERMIT FEES . APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft` >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 ' >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= S• o (number) - ` Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee ZS D projcost �FTHE Tp� ti The Town of Barnstable 9B&AM AS& ;erg Regulatory Services `bA 1039. A° Thomas F. Geiler, Director rE0 MA'1 Building Division Peter F. DiMatteo, Building-Commissioner 367 Main Street.Hyannis MA 02601 Fax: 508-790-6230 Office: 508-862-4038 HOMEOWNER LICENSE EXEMPTION Please Print DATE: � �l e.�e �t-er►�CrVI� �� � � JOB LOCATION: 2 treet s village (,, number it i�ri�eci "HOMEOWNER": home phone# work phone# name CURRENT MAILING ADDRESS: zip code city/tow stare n Is of six units or ing The current exemption for"homeowners"was extended to hire ho domes not possess a license,a ova at less and to allow homeowners to engage an individual fo the owner acts as supervisor. DEFIIVTTION OF HOMEOWNER or is Person(s)who owns a parcel of land on Yvhich or detached structures accessory to such useresides.or intends to reside,on which there ,and/or intended to be,a one or two-family dwelling,attached farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building,permi + t. (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 theta n of Barnstable a Il comply withh said no Department minimum inspection procedures and requirements and proced d requireme ture eownerSi a Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the Staie Building Code Section 127.0 Construction Control. HOMEOWNER'S EMWrION g permit is required shall be exempt from the The Code states that: "Any homeowner performing work for which a buildin p 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 supervisareor." Many homeownersRegulations foracesexemption are Licensing ConstructionSu a ware that theyecdon 2.15)assu the ming lack oof awareness often results in e Appendix Q,Rules&R gala unlicensed responsible. serious problems.particularly when '�a the homeowner licensed Supervisors The homeowner acting asthisSuper our o Bo ultimately ard cannot proceed against the unlicensed person as communities require.as part of the perrtut To ensure that the homeowner is fully aware of his/her responsibilities.many 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 formicertification for use in your community. Q:FORMS:EXEMVM I ME T Town of Barnstable *Permit ( P� o{yti Ezpirts 6 monJis born issue care `! Regulatory Services Fee Thomas F.Geiler,Director l0 �� I 04 '°rFo►u.�'" Building Division Peter F.DiMatteo, Building Commissioner X-PRESS PERMIT 3 6 7 Main Street, Hyannis,MA 02601 w. O C T 17 2 O O 1 Office: 508-862--=038 Fax: 508-7 90-6230 RNSTABLE EXPRESS PERMIT APPLICATION - RESIDE @§ Not Valid without Red X-Press Imprint Mapiparcel Number Q Property Address u Value of Work Residential Owner's Name&:Address G 2 2 . 0— 0 Telephone Number J " ��� 4 4 u Contractor's Name Home Improvement Contractor License#(if applicable) Construction Supervisor's License=(if applicable) r r ❑Workman's Compensation Insurance Check ❑ am a sole proprietor I am the Homeosmer ❑ I have Worker's Compensation Insurance Insurance Company Name Worlamn's Comp.Policy Permit Request(check box) Q Re-roof(stripping old shingles) ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Re lacement«'indo%s. U-Value ( 44) Other(specify) I Q •Where required: Issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic.conservation.::c. Signature Q:Formu:espmtrc:rev-07060l l ,I " °ft r Town of Barnstable Regulatory Services BABNSrABUI ' Thomas F.Geiler,Director 9�A 1 9.�s p,0g, lEo� ., Building Division Ralph Crossen,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 SHED REGISTRATION y Location of shed(address) Village Property owner's name Telephone number ox 12— Size of Shed Map/Parcel# Signature Date r Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg # 25 y STANDARD LEGEND NOTE:not all symbols will appear on a map q Z GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH _ ORCHARD OR NURSERY v—v v V EDGE OF CONIFEROUS TREES MARSH AREA r —• -•— EDGE OF WATER DIRT ROAD 1 DRIVEWAY i PARKING LOT PAVED ROAD DRAINAGE DITCH lv S n n+► �` ————— PATH/TRAIL MAP 14 PARCEL UNE** 11 PARCEL MA NUMBER #INO HOUSE NUMBER 26 2 FOOT CONTOUR LINE —+o 10 FOOT CONTOUR LINE 4.9 SPOT ELEVATION STONEWALL FENCE RETAINING WALL MA \ f - RAIL ROAD TRACK Ip STONE JETTY 4. SWIMMING POOL PORCH/DECK BUILDING/STRUCTURE "L DOCK/PIER/JETTY HYDRANT 9 VALVE 0 MANHOLE O POST O" FLAG POLE T O W N O F B A R N S T A B L 6 0 8 0 0 R A P H I C I N F O R M A T I O N S Y S T 8 M S U N I T o SIGN ® STORMORAIN N FEET *NOTE:This map a an m emart of o s*NOTE The parcel Dees are ongraphic resenWicas DATA SOURCES:Planimettirs man-made featums were i photag phs by The James r; D �A Po N mP ( ) merpreted from 1995 aerial a i4,4 a 1'=100'sale map and may NOT meet of pmpedy bourrdories They arm not he location and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial Dlavaphs by GEOD o UTILITY POLE a TOWER =t' 0 2S SO Notiorrd Map Ammecy Standards at tha do not represent actual relationships to physical obie� Corporation. Plonimehiq topography,and vegetation were mapped to meet Nafioed Map Accuracy Standards i 111101=SO FEET* enhrged sale. on the map. at a scale of 1'=I ff. Parcel linos were d qWW Cam 1999 Town of Barnstable Assesso(s tax maps. O. LIGHT POLL o maRK BOX lsitemaps\Pub1id\m147p48.dgn Feb. 23, 2000 10:07:17 1`' s TFIE Thy,_ Town of Barnstable Regulatory Services a�uvsr"si.e. Thomas F.Geller,Director Muss. 9 i639 Building Division Ralph Crossen,Building Commissioner - 367 Main Street, Hyannis,MA 02601 o . Office: 508-862-4038` Fax: 508-790-6230 SHED REGISTRATION Location of shed(address) Village rn wheel L 7ah e746 �a�e�- Property owner's name Telephone number Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) 1 - 1 PLEASE NOTE: IF YOU ARE WITS IIK THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. �( THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg STANDARD LEGEND # 25 NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH _ ORCHARD OR NURSERY v—v V—v EDGE OF CONIFEROUS TREES l \t MARSH AREA t_ —• • — EDGE OF WATER DIRT ROAD 1 DRIVEWAY �—PARKING LOT ~ 1 ��PAVED ROAD cal? ------- DRAINAGE DITCH kl ` l ----- PATH TRAIL A PARCEIUNE** MAP 14 � W 110-* --MAP# 21 E PARCEL NUMBER #1860— HOUSE NUMBER # 2 -- — — 2 FOOT CONTOUR LINE fj io 10 FOOT CONTOUR LINE ONO >/4.9 SPOT ELEVATION STONE WALL j., FENCE RETAINING WALL ' '` RAIL ROAD TRACK MA 7 c==7====> STONE JETTY �\ SWIMMING POOL 4� \ PORCH/DECK ❑ BUILDING/STRUCTURE F'-T=L DOCK/PIER/JETTY fT • `� . � HYDRANT e VALVE O MANHOLE j O POST OR FLAG POLE I T W N O F B A R N S T A B L E G E O G R A P H I C I N F O R M A T I O N S Y S T E M S U N I T v SIGN ® STORMDRAIN ii PRINKED SWF IN FEET *NOTE:This rtra a an enlargement al a **NOTE:The anal roes ore only graphic representations DATA SOURCES:Plonimehia(man-made features were interpreted from 1995 oeriai m n p r9 P ( ) D photog phsbyTheJames 0 UTILITY POLE n TOWER w e 1°=100'scale map crtd may NOT meet of properly boundaries They are not he locations,and W.Sewall Company.Topography and Vegetation were irrmrproted loom 1989 aerial photographs by GEOD 0 25 50 National Ma kvmq Standards at the do not mpresent actual relationships to physical objects Corporation. Planimehfa,topography,and Vegetation were mapped to meet Noticed Map Amrrocy Standards * enlarged scale. on the at o scab of 1 Z I OD'. Parcel lines were d'Deed from 1999 Town of Bamstable Assessor's tax ma ¢ LIGHT POLE o ELECTRIC BOX r 110=SO FEET � p. r9� Ps ' lsitemaps\Pub1ic\m147p48.dgn Feb. 23, 2000 10:07:17 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 9 Permit# �/� Health Division � �r� �� Zora-��C Date Issued .�— o; Conservation Division s o 511 a o9 9 Fee Tax Collector SEPTIC SYSTEM MUST BE Treasurer Q I�a INSTAI�E,EDfM-COLUNCE j Planning Dept. w�' 'a ENVIRONMt.NTAf CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Z-6 W& l A e4ya P. � Village MOAdfMA IM15 Owner ",,Pl + L(2.bei-� I IA�_( ' Address Z e�, , a, Telephone Permit Request ( 9-+ X 3 3 oAf . W041t uu v � • Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost D•Uv Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Ctug_ Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. 'Dwelling Type: Single Family Z Two Family ❑ Multi-Family(#units) Age of Existing Structure w, Historic House: ❑Yes o On Old King's Highway: ❑Yes Ao Basement Type: ®'Full ❑.Crawl El Walkout ❑Other �� Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing -L new Half:existing new f Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing new First Floor Room Count y t Heat Type and Fuel: Vas ❑Oil ❑Electric ❑Other Central Air: ❑Yes EJ�No Fireplaces: Existing b New Existing wood/coal stove: O'Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size ( Attached garage:E existing ❑new size Shed:❑existing ❑new size Other: 1 Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes C/No If yes,site plan review# Curt Use Proposed Use BUILDER INFORMATION Name A?_2b _mot Telephone Number Address --he License# Home Improvement Contractor# 6`2,6 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO :SIGNATURE — f DATE _ 5 ' 1Z-lw Y _ FOR OFFICIAL USE ONLY t g PERMIT NO. k DATE ISSUED 4: T MAP/PARCEL NO. ADDRESS VILLAGE OWNER t DATE OF INSPECTIOI i FOUNDATION FRAME INSULATION z , a FIREPLACE - ELECTRICAL: ROUGH FINAL ' PLUMBING: ROK'(91P ' FINAL te b GAS: ROLE+► FINAL ' tc FINAL BUILDING. co� m r DATE CLOSED OUT go i 0 ' i-, m N ' ti ASSOCIATION PLAN M # 25 NOTE: LEGEND E:not all symbols will appear on a map GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH _ ORCHARD OR NURSERY v—v—v EDGE OF CONIFEROUS TREES MARSH AREA —•• — EDGE OF WATER 'NP ___= DIRT ROAD DRIVEWAY / PARKING LOT PAVED ROAD g — — DRAINAGE DITCH PATH/TRAI L - AMP �� ' PARCEL LINE** ,�. #0 its MAP# 21& PARCEL NUMBER U 91860— HOUSE NUMBER 2 FOOT CONTOUR LINE — i0— 10 FOOT.CONTOUR LINE X4.9 SPOT ELEVATION STONE WALL b FENCE RETAINING WALL ---- RAIL ROAD TRACK MA 7 / STONE JETTY SWUN,WING POOL 4•• �e • Q \\� �;� PORCH/DECK Q ] 0 BUILDING/STRUCTURE - DOCK/PIER/JETTY HYDRANT 6 VALVE O MANHOLE O POST OFP FLAGPOLE T O W N O F B A R N S T A B L E G E O G R A P H I C I N F O R M A T I O N S Y S T E M S U N I T v SIGH ®-,STORM.DRAIN N PRINTED SCAIF IN FEET *NOTE This crop is an enlargement of a **NOTE.The parcel lines are only graphic representations DATA SOURCES:Manimetrics(man-erode features)we interpreted from 199S aerial photographs by The James w,y. =e - 1'=1W sails map and may NOT meet of properly boundaries They are not he locmiaq and W.Sewall Comparry.Topography and vegetation were interpreted from 19D9 aerial photographs by GEOD 0 UTIUPI POLE n TOWER �i 0 25 50 Noticed Map Amiracy Standards at this do not represent actual relationships to physical objects Corporotiori. Planimetria,topography,and vegetation were mapped to meet National Map Amirocy Standards 1 INUI=SO FEET* enlarged scale. on the map. at a scale of I°=100'. Parcel lines were digfiaed from 1999 Town of Bomstalile Assessors tax maps. LIGHT POLE O ELECf RIC BOX ...lsitemaps\Public\m147p48.dgn Feb. 23, 2000 10:07:17 FRAME CONSTRUCTION TWO PIECE Tap CONNECTOR 9"TOP RAIL PLASTIC LINER-LOC COPING- SELF-SUPPORTING STABILIZER BAR GALVANIZED TOP PLATE WALL CLOSURE SKIMMER SEAL EXTRA DEEP CORRO•RIBBED WALL 7.5"VERTICAL SUPPORTS EPDXY COATED GALVANIZED UNDERFRAME GALVANIZED BOTTOM PLATE WALL&FRAME COATINGS INSIDE OUTSIDE ALKALINE CLEANED ALKALINE CLEANED ZINC COATING - ZINC COATING ALKALINE CLEANED ♦`� ALKALINE CLEANED ' BONDERIZING COATING r BONDERIZING COATING CHROMIC RINSE-♦ r/ CHROMIC RINSE (CORROSION ., (CORROSION PROTECTION) PROTECTION) FULL COAT BAKED ON BAKED ON ENAMEL FINISH ENAMEL FINISH - (FRAME) BAKED ON"TEXTURE BAKED ON KOTE"FINISH(FRAME) Epoxy FINISH (WALL) SHAPE SIZE METRES VOLUME U.S.GAL LITRES ROUND POOL 48" 15 x 48" 4.57 x 1.22 4,715 17,850 18 x 48" 5.49 x 1.22 6,752 25,560 21 x 48" 6.40 x 1.22 9,341 35,360 24 x 48" 7.32 x 1.22 12,133 45,930 0 27 x 48" 8.23 x 1.22 15,200 57,540 30 x 48" 9.14 x 1.22 18,928 71,650 ROUND POOL 52" 15 x 52" 4.57 x 1.32 5,019 18,997 18 x 5211 5.49 x 1.32 7,186 27,202 21 x 52" 6.40 x 1.32 9,941 37,631 24 x 52" 7.32 x 1.32 12,913 48,881 0 27 x 52" 8.23 x 1.32 16,177 61,237 30 x 5211 9.14 x 1.32 20,708 78,388 OVAL POOL 48" 12 x 24 x 48" 3.66 x 7.32 x 1.22 6,843 25,903 15 x 24 x 48" 4.57 x 7.32 x 1.22 8,330 31,532 15 x 30 x 4811 4.57 x 9.14 x 1.22 10,692 40,472 18 x 33 x 48" 5.49 x 10.1 x 1.22 13,982 52,929 OVAL POOL 52" 12 x 24 x 52" 3.66 x 7.32 x 1.32 7,300 27,633 15 x 24 x 52" 4.57 x 7.32 x 1.32 9,110 34,484 1 4.57 x 9.14 x 1.32 11,430 43,270 x 33 x 52" 5.49 x 10.1 x 1.32 14,880 56,330 toll, 4wt a ATLANTIC = m Q 0° The Town. of Barnstable. t 'O`'tio Department of Health Safety and Environmental Services Building Division ' RARNSMBLE, ' 367 Main Street,Hyannis MA 02601 9 MASS �ATED�AA'1► Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street l village "HOMEOWNER": Z/Z�/,r%7�'l name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum ins ection procedures and requirements and that he/she will comply with said proc ures a requirem Si tore of Ho er 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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN °TIME A The Town of Barnstable BAMSTAM Department of Health Safety and Environmental Services 1 N1A. 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. LL / Type of Work: ���/ l h S7`��( t �;or� Estimated Cost 2oU. .96 Address of Work: 2cf we.5, tiaO'Le 0.,Zz Owner's Name: Date of Application: O J I hereby certify that: Registration is not required for the following reason(s): ['York excluded by law []Job Under$1,000 []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 IMPROVEMENT 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 S' Z of Date ner's Nam I g1orms:Affidav �� The Commonwealth of Massachusetts .. Department of Industrial Accidents office of/asesaffolions 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit �Z name: . location: �l V gza city '"'� hone# I am a homeowner performing all work myself. ❑ I am a sole vroprietor and have no one working in any capacitv % %/////////%/%%%%%%/////%/%////%///%///////////%/%/%/%%/%�%%%�%%%/��%%�%/��%%%�%%%%/%/ an employer rovidin workers'compensation for my employees working on this job. ❑ .... ...............:::.:::.::.::::::::::::: ::..::::::.::::::::::::::::::..::::.:::::.:.:.:.:::::::::::::::::::::::::::::::::....:::::. ::.::::.::::::::::::::.::. M. com anv n aye :.. p h C1 < iry of ins� %/. am a sole proprietor,general contractor, or homeowner(circle one I )and have hired the contractors listed below who oe , the following in workers' compensation olices: : :: : : :. .... .....::....... .... .... . .... .. .. .m . : : : : eoe::anvnam . H: mom: 'sddres ............. .................. ........................................... tv' X. .................................................................... .................................. ..... ..................................... tv .....:::::::..... 'lnsrirance..c M. co anv [i j5iaii` 'z%�5?>`' iyi4il<? i:' 3ii ad dr en .....::::.:.::..:.:.......... CL 0 ai�tirancXX Faffure to secure coverage o,req�red under Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S 100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify the p penaftieslfpedury that the information provided above is trw and Co at Signature Date S L _ Print name l`G o Phone oMdal use only do not write in this area to be completed by city or town ofacial city or town: peemitilicense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office _ ❑Health Department contactper,on: phone#; ❑Other (revised 9/95 PIA) Information and Instructions mP. workers'w rrovide compensation for their Massachusetts General Laws chapter 152 section 25 requires all employers to p o employees. As quoted from the "law", 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 section 25 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,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. im Applicants ' Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. 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 Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned fo the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Imlesdoadons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 f w .Y. I,alk, SCALE� APPROVED BY: DRAWN DATE: REVISED DRAW04Q NUMBER