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0170 WHISTLEBERRY DRIVE
�err r 've r , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION,,., Map Parcel`' �.�� `Apphca ion# Health Division 'Date Issued Conservation Division ' A Pp lication Fee ; ,3iS Planning Dept: _ Perm it Fee �� Date Definitive.Plan Approved by Planning Board Historic - OKH Preservation / Hyannis r Project Street Address VillageR���•..a 11r�1p IVY Owner , S I P S j<ri Address .��► Telephone d+ - - Permit Request © i& Square feet: 1 st floor: existing proposed :2nd floor: existing proposed Total new lA Zoning District Flood Plain Groundwater Overlay %*o®� Project Valuatio Ah"W24*5im 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 r Historic House: ❑Yes )k No On Old King's Highway: ❑Yes ❑ No Basement Type: A Full ❑ Crawl Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) v Number of Baths: Full: existing J, new Half: existing new-, y Number of Bedrooms: existing _new N ti , Total Room Count (not including baths): existing new First Floor Ro p Count,, ?' Heat Type and Fuel: ❑ Gas X Oil ❑ Electric ❑ Other k Central Air: El No Fireplaces: Existing_/ New Existing wood oal stcav�p: ❑�'es>6 No Detached garage: 0 existing ❑ new size—Pool:10 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name I k Telephone Number �d c�r�'� L / Address License # C 6.af-,IeA Home Improvement Contractor# 1377 V L Worker's Compensation # 76 iyeq! /VA/9-6P ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO yU SIGNATURE / DATE r� ' FOR OFFICIAL USE ONLY t 4r4'APPLICATION# DATE ISSUED - k MAP/PARCEL N0 i ADDRESS VILLAGE OWNER ; DATE OF INSPECTION: _FOUNDATION FRAME 1 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING- ROUGH FINAL '_GAS: ROUGH FINAL FINAL BUILDING I DATE CLOSED OUT ASSOCIATION PLAN Na. �- i The Commonwealth ofMassachusetts ,Department of 1ndustrial,4ccidents Office of fnvesfigations 600 Washington Street Boston, AL4 02111 www.rn ass.go v/dia Workers' Compensation insurance A.fBdavit: Builders/Contractors/Electri.ciaas/P.4umbErg A licant Information please Print Le�iblY Name (Businrss/OrganiL ba/Lndividual):— Address: City/State/Zip: + Ph ME, °77k —5J � 7 Are you an employer? Check e appropriate box: Type of project(required): 1.❑ I am a employer with 4. F<] I am a general contractor and f' 6. ❑Ncw construction employees(full and/or part-time).* have lured the sub-contractors 2.❑ I am a sole proprietor or partnrr- listed on the attiched sheet 7. ® Remodeling ship and have uo employees nr-sc sub-contractors have g• Demolition employees and have workers' working for me in any capacity. t 9. ❑ Building addition [No workers' camp.•innirancc �� ine,�ranee. rbquircd_] S. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a horanownez doing all work officers have exercised their 11.❑k?lnnnbing repairs or additions myself- [No workers' comp. right of exemption per MGL 12 ❑Roof repairs c. 152, §1(4), and we havt no inc�Trance requizrd_]t -13.❑ Other employees. [No workers' comp.insurance required-] 'Any applicant that chcckr box#1 roust also fill out the cation below showing their workers'coropcnsaADn policy information tt,H, omeowners who rubroit this of davit indicating they arc doing all work and thrn hire outside contractors must rubrmt a new affidavit indicatmg such. h,=h'detors that ebccIcft&box must attacbcd an additional rhea showing the name of the sub-ontraclurr and stain whether ornat those entities have employees. if the sub-contractnrr have mTp)oyctr,thry must pravi db their workar'comp.policy nurnber. I am an employer that is providing workers' compensation insurance for my employees. RaLow is the policy and jab site info rm.adon. Inmi ancc Company Name: Policy#or Self--ins. Lic. #: 7 1 D MP I k R�` Expiration D ate:^� -0%. Job Site Addrrss:_j2 0 1,0 i S•4�,c 1, ,IA& City/StatdZip: M tug•-w, t t l(S, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.tmdcr Section 25A of MGL c. 152 can lead to the imposition of rrirnirial penalties of-EL firm tip to $,1,500.00 and/or one-year imprisonment, as well as ei)21 penaltirs in thr form of a STOP WORK ORDER and a fine ' of up to$250.00 a day against the violator. Bc advised that a copy of this statLmerit may be forwarded to the Officc of _ Iuyestigations of the DIA for in u-a- ce coverage verification. I do hereby cc der the pain s•and penalties of perjury that the information provided above is true and correct. Si atruc: / Date: Phone#: Official use only. Do not write in this area, to be compLde-d by city or town ofj'xW City or Town: Permit/Licerim# Issuing Authority (circle one); ,;1, 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their cmployecs: pursuant to this statute, am employee is defined as "...every person in the service of another under any contract of hire, express or irplied, 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 meiver or trustee of anindividual,paiincrship, 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 jw,Ding house of another who employs persons to do maintenance, construction or rcpau work on such dwelling boost )r on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." viGL chapter 152, §25C(6) also states that"every state or Iocal licensing agency shall withhold the issuance or enewal of a license or permit to operate a business or to construct buildings in the commonwealth for any n.pplicaat who has not produced-acceptable evidence of compliance with the insurance coverage required." �dditionaIly,MGL ohapter 152, §25C(� states `Neither the commonwealth nor any of its political subdivisions shall Inter into any contract for the performance of-public work until acceptable evidence of compliznce with the insurance equirements of this chapter have been presented to the contr�ting authority.' ,pplicants lease fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, it ecessary,supply'sub-cantractor(s)name(s), addresses) and phone numbcr(s) along with their certi.ficate(s)of m ance. Limited Liability Companics(LLC) or Limited Liability Partocrships (LLP)with no employees other than the cembers or partners, arc not required to carry workers' compensation in&urancc. If an LLC or LLP does have rployecs, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial ceidcuts for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should returned to the city or town that the application for the pcuit or license is being rcqucstcd, not the Department of cdustrial Accidents. Should you have any questions regarding the law or if you are rcgnired to obtain a workers' )mpensation policy,please cell the Department at the nurrlber listed below. Self-insured companies should enter their :if ing ranr o license number on the appropriate line. ity or Tows Officials ease be sure that the affidavit is complete. and printed legibly. The Department has provided a'space at the bottom 'the affidavit for you to fill out in the-event the Office of Investigations has to contact you regarding the applicant case be sure to fill in the permit/liccosc number which will be used as a rcfcrcncc nvmbcr. In addition, an applicant rt must submit multiple permit/license applications in any given year, need only submit onp affidavit indicating current Vey information(if necessary) and under`Job Site Address" the applicant should write"all locations in (city or Nn)."A copy of the afl5davit that has been officially stamped or marked by the city or town may be provided to the plicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit,must-be filled out each ir.Whore a.home owner or citizen is obtain] a license or permif not rclatcd fo any business or commercial venture :, a dog license or permit to bum leaves etc.) said persoii is NOT required to complete this affidavit e Office of Investigations would leke to than you in advance for your cooperation and should you have any questions, asc do not hesitate to give us a call. Department's address, tclephone•and fax number. Tha C6mmmwcalth of Massachusetts Dcpartment of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4.90.0 ext 4.06 or 1-V7-MASSAFB Fax # 617-727-77491 . 11-22-06 www.mass.gov/dia Town of Barnstable Regulatory Services &ARNSTABLE, rsAss. g, Thomas F. Geiler,Director 0 �,�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 Property Owner Must Complete and Sign This Section If Using A Builder i, ��� t c .,2 V� wS�1 , as Owner of the subject property hereby authorize 5,016 +� ��-, J/r c /+PCvd3 1 � �' to act on my behalf, in all.matters relative to work authorized by this building permit application for: r-� n i LOA 11 (Address of Job) ignature of Owner Date V Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form,on the reverse side. Town of Barnstable SOPiHE ray o Regulatory Services Thomas F.Geiler,Director • SARNSTABEZ. _ Q MASS 1b Building Division PrED �p Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 R'ww.toym.barnsiable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOh kOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwells 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 ROMEOWNER 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 inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner perforating 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 supaysor." Many homeowners who use this exemption aie unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would With a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a forr/ecrtification for use in your community. /12:04:59 1BG63790222 -> The Hartford Fax Page 003 , CORD, CERTIFICATE OF LIABILITY INSURANCE LBR DA7f uoBs 09-05-2008 ReaUVEN THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PAYCHEX AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE . HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 210705 P: () — F.- () — ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 308 FARMINGTON AVE INSURERS AFFORDING COVERAGE FARMINGTON CT 06032 INSURED INSURERA:Twin City Fire Ins Co INSURER B: LEWIS & WELDON CUSTOM CABINETR Y LLC INSURERC: 111 AIRPORT RD. INSURER 0: HYANNI S MA 02601 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSR TR TYPE OF INSURANCE i'OL/CY NUMBER POL/CV EFFECr/VE POLICY EXPIRATION LIIW?8 GENERAL L/AB/LIrV EACH OCCURRENCE a COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one rue) e CLAIMS MADE OCCUR MED EXP(Any one Person) e PERSONAL&AD V INJURY - a GENERAL AGGREGATE a GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG 8 POLICY PRO- LOG' AUTOMOBILE UASIL/TV COMBINED SINGLE LIMIT a ANY AUTO (Ea aoaident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) e HIRED AUTOS ' BODILY INJURY e NON-OWNED AUT09 (Per eccldeni3 PROPERTY DAMAGE a (Per aoaident) GARAGE LIABILITY AUTO ONLY.EA ACCIDENT 8 ANY AUTO OTHER THAN EA ACC 8 AUTO ONLY: - AGG a EXCESS LIABILITY EACH OCCURRENCE a OCCUR CLAIMS MADE AGGREGATE 8 0 DEDUCTIBLE a RETENTION a a WORKERS COMPENSA VON AND x TORY WC LIMIT OTH- ER A EMPLOYERS'L/AB/L/TY 76 WEG NP1808 05/10/08 05/10/09 E.L,EACH ACCIDENT e100 000 E.L.DISEASE.EA EMPLOYEE 0100, 000 E.L.DISEASE.POLICY LIMIT 6500, 000 OTHER DESCRIPTION Of OPERATIONSd OCA T/ONS/VEMCLES/EXCLUS/ONS ADDED BY ENDORSEMENTISPSC/AL PROV/S/ONS Those usual to the Insured' s Operations . Re: working on house, kictchen cabinetry and interior remodeling for Richard Lilak 26 Appaloosa Way Marstons Mills, MA, 02648 CERTIFICATE HOLDER ADD/T/ONALINSURED;INSURER LETTER. _ CANCELLATION SHOULD ANY OF-THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE L 1 (} ) EXPIRAt(ON DATILTHEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of Barnstable. 1 Z ;Z` PtC� S- a3S 808Z 30 DAYS WRITTEN NOTICE(10 DAYS FOR NON-PAYMENT)TO THE CERTIFICATE Bldg Department HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 200 MAIN ST t r' 4y ,} s REPRESENTATIVES. .HYANNIS,MA;02601 3`18y1'> �?3� 3:� i�,; AUTHORED RFYRFSENTAT/VE ACORD. 25-S (7/97) ACORD CORPORATION 1988 , r $oard oBBu oiriggegu7'afi'ans and Standards. H lug :` ME iIMP,itOV�MENT CONTRACTOR R.egjs'.t4lPf. 1;3774.6 1=xpara�ion 1'/�/20.09 Ti# 12626$ lr v$,dual J'O`HN 1F.,GILUS J.Oft GfULTS 4'0 LQA•lROO`S'E't�N MARSfi:OtJ$MI'LLS,IMA�Q264:8 ABpNhhs_Ciator I Board of BuildingUegulations and Standards Construction Supervisor. License Licensedaf : CS 51497 B[the�1.1/_.13/1947 Expi?atk py' ,2008 Tr# 6314 _.. e fs nc ni i JOHN F GILLIS 10 LEDA-ROSE LN MARSTONS MILLS,MA 0 62 48 y Commissioner L 9� Ele c- YLILA fi� ` `.. 1 V ./ � � � ti 1 '� � �+ � � � ^ .`\ _ by ,•`�-- -• � � � .�}���� � , , .. � . J �� 4- -t- o)z i i I j I i I off! j j I I i i j I i i i• i � `i\ � �i i � I I ! 1 �j i• J._ .I. - i j ' I i I I i �• j ' I I I I � � � l� gf�°�I j ; i i I ► j i I r j�j :�! v"!.S4"o i ' I • j I i � i � � j i I j j j I � I i I I • I j I i I ; I I I I I c I i i I I �� ` ♦ I I ' I I r�API I ! p S ► ! ! I I I 1. �I I �oCD k- 60! �L I i I I • ! I I I { I ' I I � j I � i Lewis and Weldon Custom Kitchens Sheila and John Slavinsky 170 Wistleberry Drive 111 Airport.Rd Marstons Mills, MA Hyannis, MA 02601 508-420-0425 Telephone`508-778-5757 Fax 508-778-5111 07-12-08 Not To Scale Room 1 #1 , ' 134 7/16 3/4=2 3/451f 3/4=2 60' 1 6-131/4 24 314 24 131/�1/16 qq,, ' . . - #9 131/131/b0,31/4 El .. �..131/4/31 131/4❑ 882 2I4 84 4 a I 24 21 O . .I • . I� 8 43/32 24 _30114 �171/2 ""-'1 r 3434 �ej31l4 ' 3/4 13 1 �- *� y+a. :,..-mas:u-=as��x+c+x+ars�.,.aacucr�x:xv..r�.cs•4 13 1/4 3 . 47 4 •Z C5 4 . ,4 a _ 2Iq 12 s _ #14 24 24 24 4 , 2a za l I _ 4 27 1 /2 27 �: 27 ' 27. 1 /2 3/4 1�4 5 r e 24 ._� 0.::Fiiffr8ra 13 k 8 461/2 �n 7 1691116#2 ' 131/4 3 .171 1/16 tr ✓7�3 . 3L 30 r 2 *1 4 Final Design - + Y ,2 3,4! ' 14 s4 ' . ., 26 26 26 ,-1,,K 30 jx.t 30 \O• 30 1/2 33 45 #4 54 1/8 76 561/2 26 18 46 . 26 ' #86 79 p Q 00 -.j- - YAl Rol. Re n I A—f — o tj t Iui. �_._i'92 fX��• � .------------ --- --- — --- �1cziz i Liberty Mutual Group Liberty P.O.Box 9090 Mutual. Dover,NI-I 03821-9090. Telephone(800)653-7893 Fax(603)-245-5330 September 8,2008 LEWIS'&WHELDON 111 AIRPORT ROAD HYANNIS, MA 02601- RE: Certificate of Workers Compensltion Insurance Insured: MICHAEL SAWICKI = c� 37 DEERFIELD RD MASHPI:E, NIA 02649 Policy Number: \VC2-31S-334094-018 Effective: 4/16/2008 Expiration: 4/16/2009 Coverage afforded under Workers Compensation Law of the following state(s): INIA Employcis.Liability(Limits I Sole Proprietor/Partner Coverage Election Bodily Injury By Accident: $100,000 Each Accident The workers'compensation poGcydoesnot pi:ovidc Bodily Injury.by Disease: 100,000 Each,Person' coverage for: Bodily Injury l y Disease: 500,000 ' Policy Limits NUCI-IAI-L.. SAWICKI i As of this.date,the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed.above. The insurance afforded by the listed policy is subject to all the.terms;exclusions and conditions,and is not altered by any requirement, term or condition of any or other documents with respect to which illu certificate may be issued. T1us certificate is issued as a matter of information only and confers no right upon you, the certificate holder. This,certificate is not an insurance polity and does not amend,extend,or alter the coverage afforded by the policy listed.above. If this:policy is cancelled before the stated expiration,date,Liberty Mutual will endeavor to notify you of fi such cancellation, AUMORIZED REPRESENTATIVE LIBERTY MUTUAL INSURANCE GROUP 7111s Certificate is:executed by LIBERTY MUTUAL INSURANCE GROUP 5s respects such inswance as is afforded by Those companies. cc:"7nsurcd Producer of Record: MICHAEL SAWICKI MARSHALL K LOVEL.ETTE INS AGCY 37 DEERFIELD RD P O BOX 836 MASHPEE, M-A 02649 WLS•T'YARMOUTH, IVA 02673 9/s%2(og m a: Mok OM :Michael R Sawicki, Electrician FAX NO. :508-477-0917 Jan. 15 200e 11:39AM P1 s . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electlrlclaiis/Pluutbers Applicant Information Please Print Leeib.Iv. Name(Business/Organization/Individual): M►C,h(,{$ L 5(l I 1 1 �1 LI1 (t Vl c-d F e i l' 11 Glkt2n Address:_3 r? 1l PP r City/State/Zip: HO QdjLq_q Phone.#: 509-q r7 9 I "']. Are you-an employer?Check the appropriate boar: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I mployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.l_y T am a tole proprietor or partner- listed on the attached sheet. 7. Rernodeling shipand have no employees These sub-contractors have 8. ❑Demolition working for the in any capacity. employees and have workers' y guild' addition [No workers'comp.•ir►surancc comp.insurance.i �. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or.additions. 3.❑ I am a homeowner doingall work officers have exercised heir 11.0 Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12 Ej Roof repairs insurance required.)t c. 152,§1(4), and we have no employees. No workers' 13.❑Other . comp.insurance required.] . 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy iNfbtmation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 7Contractors that check this box most attached an additional sheet showing the name of the sub-contraetors mnd state whether or not those entities have employees. If the sub-contracton have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers compensation Insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#.or Self-ins.'Lic. #: Expiration Date: Joh.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 crimirial penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of tip to$250.00 a day against the violator. Re advised that a copy of this statemmit may be forwarded to the Office of Investigations of the DIA_for insurance coverage verification Ido hereby certify under the pains andpenallies ofperjury that the information provided above'ic true and correct Signature: 115 1. C Date: / Phone#- �/ '9'77- Official use only. Do not write in this area,to be complete y cky or town of j7claL City or Tow>ir Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department I City/Town Clerk 4.Electrfeal Inspector 5.Plumbing Ynspector 6.Other Contact Person: Phone#: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 •� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers APPUcant Information Please Print Lelzibly Name(Business/Organization/Individual): Address-_6, I co ! b sk I-, City/State/Zip: S t,�a ,e . y✓l. q Phone.#: Jly� a q6 2621 Are you an employer? Check the appropriate bog: Type of project(required): 1.Elm I am a employer with 4. ❑ I a a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.1 I am a'sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors have Demolition ship and have no employees g• .❑ workingfor me in an capacity. employees and.have workers' Y P ty 9. ❑ Building addition [No workers' comp.insurance comp.insurance. ]red.re ui 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.]' 3.El I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption.per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am'an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.'Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the a7d penalties of perjury that the information provided above is true and correct Signature: c Date: r _ 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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: i ' 16:27 JAN 10''1 2008 ID: WILLIAM PALUMBO AGY FAX NO: 359-2114 #4925 PAGE: 2/2 DATE(MMIDDnmY) AGORD CERTIFICATE OF LIABILITY INSUMN.CE 1/10.�20os PRODUCER (•508)888-224'4 FAX: (508)833-0680 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION William Palumbo Insurance Agency Srydea ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 125 Route 6A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Sandwich MA 02563 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Travelers Ind Of 25.682 10.RK RA1ZMO MARK RASZAN0 INSURER B. 6 BPAMBLEBUSH DRIVE INSURER.C: INSURER D: E ORESTDALE MA 02644 INSURER E: C AG THEPOLICIES 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: CLAIMS.SHOWN MAY HAVE BEE N REDUCED BY P110 INSR D R:)DjL - POLICY EFFECTIVE POLICY EXPIRATION NSjLTRTYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YY DATE MMA)DNY LIMITS' GENERAL udeiLITY 1,000,000 COMMERCIAL GENERAL LIABLITY .DAMAGE TO.RENTED* 300 ' PREMISES � A CL'AIMS'MADE.❑OCCUR 6803093C7 PREM s.Ea ocaRence s ,000 .63 1/15/2008 1/15/2009 _M E IEXP'(Any one SE person .5,000 $ 1,000,000 GENERAL AGGREGATE $ 2,.000,000 GEN1 AGGREGATE LIMIT APPLIES PEP.: PRO S-COMPlOP AGG $ 2 OOQ,000 $ POLICY JERCT. LOC AUTOMOBILE LIABILITY ' - COMBINED SINGLE LIMIT ANYAUTO (Ea occident). $ ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Perperson) S HIRED AUTOS BODILY-INJURY NON-OANEDAUTOS -(Poracadent) $ PROPERTY DAMAGE $ (Per accident) GARAGELIABILTTY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EAACc. AUTO ONLY AGO S EXCESSAIMBRELLA:-LIABILITY OCCURRENCE $U OCCUR CLAIh1SMADE AGGREGATE $ DEDUCTIBLE 'RETENTION �WORKERS COMPENSATION AND ATU•' OTH- EMPLOYERS:LIABILITY _ ANY PROPRIETOR/PARTNER/EIfECUTIVE E.L.EACH ACCIDENT $ OFF ICERRy1EMBER.EXCLUDE D Il.yes,desaibe under E.L.DISEASE-EA EMPLOYE$ SPECIAL PROVISIONS below E.L.DISEASE-POLICYLIMIT I S OTHER DESCRIPTION OF OP.ERATONS/LOCATIONSNE-MCLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL'PROVISIONS CERTIFICATE HOLDER CANCELLATION (508)778-5111 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Lewis' & W4eldon EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR' TO MAIL. 111 Airport Road 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT;BUT Hyannis, MA 02601 FAILURE TO OO.SO-SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY.KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE John .LaRocca/SROGGR (��`�` �' '`�• �`- ACORD'25.(2001lOB) O ACORD CORPORATION 1988 INR074rnina�naa Pan.1 nl4' 8 4i, t1sI664z- Town of Barnstable- *Permit# t 98 Expires 6 months from issue date `. Regulatory Services Fee `:� Thomas F.Geiler,Director X.PRESS PERMIT Building Division Tom Perry,CBO, Building Commissioner JA_N 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us b�-QF- NSTABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number O6 , Properly Address - / Residential Value of Work �'7 J� 0 15 Minimum fee of$25.00 for work under$6000.00 owner's Name&Address o 1V ay SSA V11&61t1 - - Contractor's Name C_�5 � '"' Telephone Nunik G��� 7Z r 2 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) tOn (�to c2 - ❑VJorkman's,,Compensation Insurance Cho&one: I am a sole proprietor ❑ am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re roof(not stripping. Going over existing layers of roof) Re-side 0 Replacement Windows. U-Value (maximum•'4) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prop er must sign Property Owner Letter of Permission. Ho roveme ntractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 � Town of Barnstable Regulatory Services Thomas F.,Geiler,Director z6 ��®� Building Division 'mac►�►+ Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us - Fax: 508-790-6230 Office: 508-862.403 8 Property G�mer Must Complete and Sign This .Section If Using A Builder as Owner of the subject propettq Ap 6z to act on my behalf hereby authorize in all matters relative to work authorized by this building permit application fox: (Address of Job) Signature of tei: D to Print Name Q:F0RMS:0WNEp-ERN0SION q s _ ,,. .. rjj' __._✓/liv'��� -�, -tom. ,.,-.3 5:'- � �/k o0[jl!}f�����yy► BOuO:O�B� .� i - ¢i91 tH.- Ord§ssRds �or re���lA• W.ht�lvl�W . Ho�u!�Qv�EN���►trr�u!c Hess surd stpd ,, L �:. i1301 AA i G£OR ENTS t�' GeMISE AYAN .. . r 04 CZ c ! ,NW 028&9 Adur ssa..., .. .'... =,: . • iauopquia�: F WV '33dHS1fiN� _ 8rcpZ .ou-al' 90QZA s _ ZZ9600 SN As.- No cap as9e�; r .TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' Map O oisb Parcel 0-- Permit# 7� Healih Division W� Date Issued Conservation Division �-� 2�Z f�"I`�— Application Fee Q' Tax Collector �3 © Permit Fee d Treasurer 2 W"C SYSTEM MUST BE Planning Dept. WSTAU M IN COuKWICE NTH TITS a EWRONMENTAL CODE Alec 1 d 1 Date Definitive Plan Approved by Planning Board l°"� Historic-OKH Preservation/Hyannis TOMI REGULATIONS Project Street Address t rl o S-�—-L.$- S Village b&% -o N s )r� J L D Owner .-�/�. 'SL *-u 54,,l Address T341 W A i LY � Telephone ( ��o$>. �O —D Z� Permit Request FYI2 1 IL_ : u�a.c Square feet: 1 st floor: existing proposed 2nd floor: existing LSD proposed Total new ` 1 Zoning District Flood Plain Groundwater Overlay Project Valuation 17,o ao •o 0 Construction Type /,A//*)`b Lot Size A.C,S 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: O Yes _Jr No Basement Type: Full ❑Crawl ❑Walkout O Other Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) ,n . Number of Baths: Full: existing 2�, new (7 Half:existing O new Number of Bedrooms: existing t� _ new f� Total Room Count(not including baths): existing -new— First Floor Room Count Heat Type and Fuel: ❑Gas it ❑ Electric ❑Other Central Air: ❑Yes ;4No Fireplaces: Existing �_ New 0 Existing wood/coal stove: ❑Yes XNo Detached garage: xisting O new size1.,Pool:❑existing O new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# ----Current Use - — _ Proposed Use . BUILDER INFORMATION Name &N i eU Telephone Number I/ 0 3lq Address se_ License# }®a.� -' McA , 15?Lt sle Home Improvement Contractor#r Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ZOU?� a FOR OFFICIAL USE ONLY PERMIT NO. " 6 DATE`ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER' DATE OF INSPECTION: FOUNDATION ; -iW 1-1 c a FRAME INSULATION FIREPLACE ELECTRICAL: ROUHyyy��� FINAL' PLUMBING: ROU �� FINAL GAS: ROUOi�- FINAL FINAL BUILDING M n _- 47 DATE CLOSED OUT ��► ASSOCIATION PLAN NO: „ The Commonwealth of Massachusetts -- =-- ,Department of Industrial Accidents Ram-, OfflCe of 117YOSMANUOMT 600 Washington Street _- Baston, Mass. 02111 '3 Workers' Com ensation Insurance Affidavit .. location: 3 e Phan city ❑ •I am a homeowner performing all work myself `'//(v/O.../n...!.:./..w,./.%..:....%r..ir...%!...:...%,..,.•.+.%..}n.t%.v...•a.:.,:....,.<i%•r..../..../•,.%...o.../...%l........e.............r.%........r:......o....nv...n%......ri%..n.....Y J:.?ne}...r:..t/,..:.G.5o.,..+v..�.r..,,f/•.Y..%a...v,.../..n..rG.t..%:.d.,....:.%n..r...lh......:...n...a/...%n....v..../.....%.r..e...vJ...%•...nv...%...:......r/,.o.:.�v..•....:vn}./o.:.n/.....,/..n../,..+.../..:..e...../.,,./.w.:./...t.%...,.,.../.»..ot.%....n....r%.........-k...%:...r.:....%:..r...n..n........nvv/.a.%.n.n':..k../n...;r.%tn.•.%4n/.?•»•K...v.r%.n..o,v5::?/•!:rr/{c..a..:ti n.v....%v•::..y.rn.�p.a.:.Y•..;:....acO:..,.::...::h:..;+{•/.,.;-v/},.:;/:.:Yy Iamas rv.:%..x{:..::/?..:+�,.n:...}:..:,•/.:: :/..w//rry/:,.:?-Sti.:••L;:xn/.•:::./r:w:.../,G.:n/•rx.i/•..,.'/;}c:.:%4:.:+:..•:t•z:-:Y/;:}:r./.:•.:..•/..n::,•r::'..•/•f}t\.r./:.;i./:..•./:.Y./>+.,,/:.r..w,.Lv:•4+:>•;?r..o..r.r,.S nar./:fy::+lir/t:t,Y hti'.::•::ic•:.C:s:.f..job. .:r?o4v.t,,J•<;.b/ : n .am Cmnati0f .,}•-.r:./:h,;: •i/i%'••,.i...{/:4..:•.>:/<:•.Yny/:;'!r:%'}•••!y fv::/::?.:%3a.Nx%',•:k?}'/:3}:?%Y{,�:f;{:/}:;ir?/::i:.x?%r.f?Y .Y/'.•/:,.`'/•{iti/.:•%{••}•:}3,:.{/::Y:�Y:.S:4:y:fr:yn/;::S%::Lkv.,.J%;?!:':i.f,%:;`.•:.3{^/,:nf/5$vD;••�.yff/k?%i:;}Y.,:%.v,:;.;::%.+:•}.:y#t%:ih Yf,•}%:.::}[v;+;:b%�;i.;:.}:i%:+xi.}:$O3x:}f '}?.•4•%L;:.•}.N?/`v../ti+:%•:}.2:•.};./•,;,:•.}/.,;:;:} 3'.:4. .....n....>Y....... ...::...}:, ar..F:i${;b''Yi}}':i{??+,{Y r.. :•.J:is}}h:'wT::}: #..,:•.-.......:\......:v.. .... .:•::n•.vv...,..,.... :.........:...:....r:-:.:. ....F...,.n .:.....4..n,n,...•:::..:.n,,n.,\..•i.v. ......i:n.r-nv.. :..f.. .::Y.;'.^"ti •fY?{h:ffJrf!?;}}}:ff:k?,i:iy$iQfk:l•}}:: :f. nv?3+:• t{v.f.vT.•.};}::`{:-r,..:•:•S•},: .,.ttivi.f:r:.'�.�:v:n;v4:r.+»?-,vr:..}s}.:::.vv..\,n::vn:\•.•r:vv.•}?:{�:,vY4:v.v::•:Y:.{:.vi,:S.}nJnv::•Y::ifn......n4.ff..::: ::}4•vTnv-{.`,;5:;}:}•:{•}}:•^4?>:4±}<ff:{.....r::7. .}..:•n•$....:n anv.:::•}'+::f}::•}..:.....,;{.:v. r::.-{r..:::v:.......... ..r:}•:?t•;� r.r:•r.•..n.,..r:!.•::••.,:...,..,,.. r...... \......... :.....:•x•:,:•:+x+,-..:{•:.. ,.....i.:r::?n?.....r..::.......r.:.. .,..,,....+......I....... ,.4 r.v... }..r}.n.....::.•,+,........•n••4h{vv:::;}:::4;{,•...\..:vviv.Y........ ......:..... :. ...r..... .... .......,.... ........ ......r... ..i:+Y•}:o}}::{.:4:.,::•:•+;L•}--:!f::f. .. •`?iY::;;:FY:.:.a;{.;:.y ....4::T........ri..:.:Y..... ...:•:. ••:::.:•.;{::{?{;.Y?:•}'-?:•:;•:••:i•:?:::.,,,:......?:•f•Y}}:.�.>.•:•::.... ......,:,?.}::.ti••:?? •a}\•Y'?•..•..: 'tf!i:;:h,: , Sn n ...............::...., ...:,.n.,:.•................n{..r.:.,,•... :.,n. ......... }:.•::....:..,,:.;f.:::f}:{•Y.?:?}}#��kf. ..i.:, �•:L$:??f:±}f:.'•:. .... ...r.r..n. ..... 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Failure to secure coverage as required ender Section 15A of MGL 15S can]ead to the imposition of criminal penalties ga a See e. to S 1,500.ai and/or one yeas' ecure covem as wen as eQL penalties the form of a STOP wORK ORD$R and a one of$100.00 a dap againstme Imtderstsmd that a' ge veii>lcation copy of this statementmay be forwarded to the Office of Investigations of the DIA for covera _ . aye�ssuu,:and_corr.ect Y nzlertlre^ erns and enalPies-of-perjury tho�the-informatian_praladedab _ I do hereby c-ertifYu , p p Date Signature .-� s�-�� ., :'• ..,..• �' , o 4)U-C• :Phone# Z Quo 3 print name amcid us a only do not write m this area to b e completed by city or town OMidal pezmit/license# C3Building Department dty or town: ❑Licensing Board 0Selecbnen's Office contact person: f..N.r-A 9/95 P 1N .. � ..•. i .Information and Instructions Massachusetts General Laws chapter" section 25 requires all employers to provide workers' compensation for their employees. As quoted from tl�e `Iaw , an employee is.defined as every person' ' the service of another under any contract of hire,'express or implied, oral or written. association, corporation or other legal entity,.or any two or more of An employer is defined as an individual, partnership, _ the foregoing engaged in a Job enterprise,-and including the legal representatives of a deceased employer, or the receiver or , as or other legal entity, employing employees. However the trustee of an individual,partnership owner.of a .... dwelling house having not more thanthree 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 grounds or building appurtenant theretd 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 br 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 acid 1pplythg company names, address and phone numbers along with a certificate of insurance as all affidavits may be strial Accidents for confirmation of insurance coverage. Also be sure to sign and submitted to the Department of Indu date the affidavit, The-affidavit should'be returned to the city or town that the application for the pemut or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the`Uve'of�if Y.u ed,f6 obtain a ii6rkeis' CAmpensationpolicy.please call:the Department atthe niunlier listedbelow.: are requir t9or Towns . _ - . ' ,. ' . a, ...._}.. •. ,. - Please be sure that the affidavit is complete and printed legibly. The D epar eft has provided a space at the bottom affidavit for you to fill out in the event the Office of Investigations has to contact.you regarding the applicant. P tee+ be sure to fill tha.pemartfh�cens iitnber wliiehwilLbe used as a refeieace number. Tfie:affidavits may e'r tq•,. �b "mail or FAX unless oth6i arrangements have been made: ^- . 7 . ti the Departrnent4 y.,w . F The Office of Investigations would like to thank you in advance for you cooperation and should you have a_ny-questions, . ,. .. please do not hesitate.to give us.a call. - The Department's address,telephone and faxnumber. ' .. • The Commonwealth Of Massachusetts -Department of Industrial Accidents Gfftce of investtgatlans 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 ;: : phone#: (617) 727-4900 eat. 406, 409 or 375 _ ' TsbI, fS-z-Yh(�'s�c� ;Fossil Fast "cripi}rg Psckjo foram • Q�Mg GL►ring A= (`!.) IJ-Ytluci R-�-a1ue� R•yslua lirvalt� !Sr'1� pur�sae 3TOS to 65G0 Hestl�D��t-�*��f'� I�as�asl 0.4a 3= 13 19 10 b 93�g 1Z.. 19 R 12•!: O.s2 30 11 19 —o-�o— 2S 13 h— - 31 6 IiaRnal T 3f 19. • 19 10 ' Es AF#7E U •]s'/. GAS 13 25 VA WA ��g • y 1s'/. 0.44 3t 10 � • 19 19 No�raat 03Z 30 13 7S WA TVA N� O.IZ. 31 NIA 19 ZS 90 AFtTE :. Y 1 E'/. ' 0.42 3t. 14 10 6 y 32 19 6 90AFVE kA 1 a i. aso r. ADDRES 5 OF POPERT`f R . Z. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3, SQUARE FOOTAGE OF ALL GLA22NG' 4 % GLAZING AREA #3 DIVIDED BY#Z): SELECT PAC'KP,GE(Q--AA see chart above): OLVED METHODS OF D G ENERGY REQu"I EMENTS NOTE: OTHER MORE WV ARE AVAILABLE.•ASK US FOR'IHI5 INFORMATION. BUILDING INSPECTOR APPROVAL: •YES: N0: 4:{ORns•fg80303a Fcotnoie's to Table'J5.Z.1b:* I Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass•doors, skylieh 5, and basement windows ff located In walls that enclose conditioned ipace, but excluding opaque doors) to the gro area. expressed as a percentage, Up-to 1% of the total-glz*g am may be axcluded.from the U-value requirement. For example;3 ft=gf'decorative glass may be excluded from a building design with-3 ft of glazing area. = After January 1, 1999, glazing U-values-must be tested and documented by the manufacturer in accordance with the Nailonal' Fenestration Rating Council (NF'RC) test procedure, or'taken-from. Table 11.5.3a. U-valucs arc for whole units:'center-of-glass U-values cannot be used, a .11 The ceiling R-Yali es do not assume a raised or oversized truss construction. the tans b u e Substituted for R-3 8 insulation thickness. over the exterior walls without comprtssior; R-30 iasttlatisa lazy the swn Of cay'ry innsulation and R-38 insulation may be substitutid for R�9 iasttlation. Crag R�u�esag�be placed between insulation plus insulating sheathing (if.used). For.ventilated ceilings,.kwzLa�g. the conditioned space anti the ventilated portion of the roof. sheathing (1{used). Do not include Wall R-values represent the sum pf the wall cavity.ussulatian plus insulaemg srement could be met EITHER exterior siding, structural$heathing, and ihterior'drywa1L For example, an R-19 requ• . by R-19 cavity insulation OR R-13'cavity insulation plus K-5 insulating sbeathu4& Wall requirements 'apply to wood-frame or mass(concrete,masonry,log)wall construardas,but do not apply to metal=frame construction. •3 The floor•'rcquiremenis apply to floors*over unconditioned spaces (S¢c31 a5 unconditioned crawLspaces,basements, or garages). Floors over outside air must meet the ceiling rzquirtmmts• ' low de must `T'he entire opaque portion of any individual basement wall with as average depth less th 5dcotseof canditioncd me_t the same R-value requirement.as, above-grade walls. Wtadows and sliding gl must meet the door V-value requirement bc.�ements must be included with the other glazing. Basement dears; d-scribed in Note b. The R-value requirements are for unheated slabs,Add an additional R Z for heated slabs. if the building utilizes electric resistance heating use compliance approach 3' , or tho equipment men with sha to ll,more lowest' than one picce.of heating equipment or.more than one piece of cooling equipment, P efficiency must meet or exceed the efficiency required by tine seiestcd package- 'For'Heating•Degree Day requiremdnts of the closest city ortown see Table 35.2.1a. MOTES: 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 structzsal eampononts. b) Opaque doors in the building envelope must have a U-value no �than 0.35. Door U-values must be tested and documented by the manufacturer is.aecordaaca with the NFRC test proeedure or taken from the door U-Value in Table 11.5.3b. If a d'obr contains glass and as aggregate Ti-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 6e excluded from this regi irement'(Lc,may have a U-value greater than 035). c) if a ceiling,wall, floor,basement wall,slab-edge,or ciawi space wall component includes two or more areas with different insulation levels, the component comp avgrage R value is greater than or equal to Iles if the area-weighted Glazing or door eomponenLs 00if the -weighted,average U- the.R-value requirement for that component. 035 for o vaaue of all windows or doors is less than or equal to the U-value requimment( . ) - 43 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 1s " Building Permit Amendment $25.00 FEE VALUE WORKSHEET i NEW LIVING SPACE / square feet x$96/sq.foot= /3 a- • '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= 'Y z i I 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 (plus above if applicable) Permit Fee �Z• �� projcost f I FIKE Tom, Town of Barnstable Regulatory Services r + sanxs-rABLE, ' Thomas F.Geiler,Director Mass. 1639. n 3.a`0i 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. e 4.a�y roys . Estimated Cost Type of Work: KbT3 1a. Address of Work: IN zi LL S+k Owner's Name: b t U 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 El 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: Q I?— e ��� //0 Date "Contractoame Registration No. OR Date Owner's Name Q:forms:homeaffidav ti-0--.*.,�a ,a, .�.:.j'+l.,,e, _:.F•Y�Z4•-�..••s .N�r t'�'. �.,a.Ii•:=tis.r: -a d. ti . ;«..:R�... .: � r - _ P`oF.HE•o,,1 The Town of Barnstable BARNSTABLE. � � Department of Health Safety and Environmental Services Y MASS. 0Q' '639• �0 pr�oMa�a Building Division . 367 Main Street,Hyannis, MA 02601 i Office: 508-862-4038 ? Fax: . 508-790-6230 PLAN REVIEW Owner: J- SZA v/ y Map/Parcel: 4G3- CY6 Z-0 0 7 Project Address: OR m Builder: PAA(ICL- C-/LO cu x • The following items were noted on reviewing: u S OA/ T G /'/Z O M 6), fpd57,, l'�Lo Po s e r7 �L D G S r� j ��2✓-6 4- 4?Lr /y P'P� /r 2 5 r Ow r# /" ten- II A 3) 4 Rp Poo,,e-r CG4 rff a�" �&16��05777 60P-Zlt-1 N/ IV/Z ,V Trr/C0 Reviewed by: Date: �U�/6 Z - k q:building:forms:review NO r Tw.t Restricted 7�Qy •:> 07 • . 1 D NIEL..E � � � - f $oatd of$midi"Aegh ittlbd§and Standards MQM6 FM VEME4Y?60N( A TOR .; Tom!M DANIEL E CRO. DANIEL CROsM „ 359 RE NCY DR ° MARSTdHS MJ LS-,MA 02648 -- 'tS,dmuoa'st�ato?r r • ZZS. :�J ' 7-� -�• �? N . 5y 12 01 ± F 4L7 CO _ 4 5 Q • 144 . 4-7 I-JN/STLE VQ ,J� BE will,OF I will C� 8 Aa ► -rQ�- _►s-- l LGGFi'!/G�' = 40 0�7 ICES S1-rO��r.r . EGA C��✓G�% B E y 55 u ,eE�� a� 3a�, ,,J SyH.eo uN�✓ac tRs 3 c T,F//s� N�AC'A�7E,-O w� TAN y►1 p S.tJPOAJ.l1 ee� c 1 4OCA aa,4.4�r G�r�i-/r ��Q � WA./ C� FBC000 7- �WAI E ®y- �.saw��re�c TE a" . . • L �� /t7 c• ,�ey9i-1� D z L l/� YAK Mo uTN''� rrva rti�br �1j�,�i lk- � t >, ........... � L o CATION ---- . 9 - Lot #7. Whistlebe \�� S f W A- �h^ VILLAGE �• C E PERMIT NQ. x ID A 00 Marston Mills INSTA LLER'S NAME j A T.W. Nickerson D D R E S S Inc. 11 Rd R d f L p R R. E2- - Chath f. ... �, SteveEH O R OWNER 2 untoon r PERMIT' ISStJEp Q. Z Z D A T E iy 1. . :. COMPLIANCE ISSUED ------------ r •r NISI i .� 4 • t ..`'�x�� .. .v. .ut.•.i'iG _�.,. d t f.G T'��'.L,7: ,33;., (�; .F?:... 1y ..r�S!'1`.,�_�..,�P��;'w �4�a '47� w "" r . UST Assessor's map and lot number ............. .......:..... SEPTIC SYSTEM M C!:::: �- of T"E Toy INSTALLED IN cofteLl - i�,)— /eyz) Sewage Permit number ....... .........I.............. ............ WITH TITLE 5 EWRONmENTAL C House number ........................................................................ 1639. TOWN OF BARNSTABLE 1301.0iNG ,INSPECTOR APPLICATION FOR PERMIT TO .....ZQC(l.. .......!;;g.(.......... ........................ TYPE OF CONSTRUCTION .....C��....... . a.ry"k.................................................................................. ......... .......C�3............104 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... TO...... .a)h1,Ib Loo--4...J-/....... ....... ............................................... ProposedUse ...jc).......(�'ar.....I....,. f ..39 ...................................................................... ........................................ 9 District ......... ...........Fire District .......... 0................................................ ..... . LA- Zonin' ............ Nameof Owner ......... ...................Address ........................................................................................ Nameof Builder ...... ..................Address .................................................................................... Nameof Architect .... .............................................................Address ............................................................... ................... Numberof Rooms ...................................................................Foundation ....C-0 A uce..k........................... ..................... Exierior .... ...............................Roofing ............................ Floors .......COY' Interior ..................................................................................... ..................................................... Heating .................UO.n.-Q...................................................Plumbing............nqi-k.t......................................................... Fireplace ..............Do n.,L...................................................Approximate Cost ...............150012.1....... Definitive Plan Approved by Planning Board --------------------------------19--------- Area ... ....................... Diagram of Lot and Building with Dimensions Fee ..... .............. .... SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 uv.....41 0 .................... Construction Supervisor's License ............. HUNTOON, STEVE ?7262.. 2 Car Garaqe No ......I........ Permit for ...........................:1........ Accessory to ...................................... ....................... Location .1.7.0...Whi.s.tleberry QriMg�.............. .. . . ...... . ......................... Mars-tons. Mills ............................................................................... Owner ........Steve Huntoon ............................................................ Type,of. Construction ...FKaM............................ ..........i'."..................................................................... • Plot ............................. Lot ................................ % Permit Granted .....NOVETn.ber...2.7J.-....-...fq 84 ........... ...... Date of Inspection .................................. 19 Dd ..te Completed .................. . -1q ...... .... 4. �ra�- �� y1�'' ,��_j�r�Y•:: �s �Y�r�,��jw, (�b�r.•1 r4,. 'f �i � �F..�_7.� G� 7�. ) �j .� r: 4fA - .�.KSs�rl ��r�Yv�•��� X/.rNV �, rl� ���"+�tr 4. ��!I.F��GITar. [�, ! /•lT` '��i Y�•I i� [ • .. '�•, • ' tom •,/r ,.. , .\... n •,[ •`T• .. • ••, ••� • • I• + ,•~ ' � � ' .'/.r� SST, Ail �4,ti�Y, 2't►♦ 7[�r:_ r.r. 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Q } ~• \ T ,IW' ,t �.� ,T. • ~-'I. lr !\ R1' , Yt'rJ 1 •� l 'a'f '1 '*`. k`r' �` s. �...� •� - l' f 4y S',f. •' 3 i '`+f'r ._t;,ia 's "�era"-� 1�L':. `'I R _ , L � � ♦ '.••� � '•,6 T' L�II YJ-..4 i 1 r • ,1 �� ..'j'�FI` •• •.�t !s =e's�. ti, Cry •,•fa,, ...•. - r r•r Yr . ,ov'-' J Assessor's map, and.lot number ......... , . .. ............... :.. THE �oF rot` Sewage Permit number ....... House number ............. a ...............:....................................:....... 9003 0� 0 m TOWN OF BARNSTABLE i BLUILDING INSPECTOR APPLICATION FOR PERMIT TO .. ........ram.............(........ 7 .�.. �........................ TYPE OF-CONSTRUCTION .....5.. C �.r-11—S..:............................................. ................................ 1... c I .......... ...... ?: ............19. ... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....1..-7.(1....... ,��. !;. .1•' !'✓Yl�.. ./J.., ..... ...}7)441e.`2n.,:. ........�..1&.C<.�>..... ................................... i ProposedUse ...O...... r.......... ��..I(`.G.... .e` ................................................................................................................ Zoning ..........................i sAn `,tr:..!.............e ..........Fire District ......... .. '...... ............................,.................... Zo g .. I - Nameof Owner .......4.),n ?,?D. ...................Address .................................................................................... Name of Builder `,4 �P......rl�.�Y�..LSJ�?1..................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .............................:....................................Foundation ....In ...........................................,...... Exterior ....�..c.C�cn .... -�......5 :�1.r ..............................Roofing �h. Y!r=.`.. ....... ....Z.l"J.l<?c,............................ J .. 'Floors .......C0.e!\(..'1A.k................................. ..................... .................................................................................... Heating ................A.)s X.A..............................................t.....Plumbing ...........nCy:4.......................................................... Fireplace ................?0D.nA................................ ................. ..Approximate. Cost ..................................... Definitive Plan Approved by Planning Board ______________________________19________. Area �� <,?........................... Diagram of Lot and Building with Dimensions Fee ...... ............. SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 �� Crl .... .I�....>:n. �. ?^.................... Construction Supervisor's License n�.2.��.`.�1............ HLNITOON, S= A=63-86 No .....27262. . Permit for ...2 Car..G.arage........ . ...... .. ....... .. .......... .............Acce.s.sory...to..DwejjjjQ(j..................... ......... . ...... .... ............. Location ....1.70..Whi.stle.ber-ry.Drive........... ...... ........ ........ Marstons..Millp............. ....................................... Owner .......Steve..H..............untpon............................... ......Steve .. Frame Type of Construction .......................................... ................................................................................ Plot ............................ Lot ................................ Permit Granted .....November 2 7 .........19 84 .......................... Date of Inspection ......................................19 Date Completed .......................................1,9 cd Assessor's map and lot number ....... ......... ` THE...........Sewage Permit number . ......................../C .. �J" � BASH9T11DLE, House'- number :......�70......................................................3 9 Nana �p i6jq. 0 O MAY a\� TOWN OF BARNSTABLE- -- BUILDING INSPECTOR vi USE APPLICATION FOR PERMIT TO .........D..........�/U ...................................................................... t.................. -TYPE OF CONSTRUCTION ............. ..�!�/..Q,.4..�I�... t, '� ....... .......................................................... -24................. -° ................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........................lht....7....... 1!/GI1.S. " .t ►�Y.4/.. !'..... )'S. .. i14S.............. ................................... Proposed Use ...........5!!��►�e-...... !!o!dl.t!�....Aam:g?e....................................................... ( - Zoning District .................L.....................................................Fire District ................................. Name of Ownerc_Sf.PK—m.....M.A(J.Y&e).Py1..................Address ... �`11 �Ar / (�Q, OY,raT ... �� ...... Name of Builder ......�..?4.W.1.d.....). .14 O.(... Kt...........Address ........ %..........,i,54w:P.............................................. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ............ .................................................Foundation VP PG�. ..G(/w.r,one_A................................. Exterior ....�L'�l. !7J_5........Roofing .....051.. ?Ilil Les................................... Floors ��h ,�UQIl. 9�i�//���. >//!!.CHIP!/rVl................lnterior ... ��SIC�:............................................................ ......... .�+ �. ...... Heating � ..�/1{ .Gtl( .... .....�1!t.............:............Plumbing ...... � r.....�...�. ?..\ .............................. .. Fireplace . r�Ge��: ./�iI4xx ........., J{,.5.....................Approximate. Cost 70 qpq� 9 -. Area ....�3 (� .............. . Definitive Plan Approved by Planning Board -----------_--_-_--____ . ......7... � Diagram of Lot and Building with Dimensions Fee .......�?./!....J..3. �...... SUBJECT TO APPROVAL OF BOARD OF HEALTH CJ¢S�4 e6/UL) { L-tyt '7 � I :qAj '� J G 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 Licensee..,_�..0................ HUNTOON, STEVEN W A=63-86 26287 11, story No ................. Permit for .................................... .......Single, Family Dwelling....................... .............. .. ...... .... ...... ........... Location Lot 7, 170 Whistleberry Dr. ................................................................ Marstons Mills ............................................................................... Owner Steven.m...,,.Hun........toon............................ ............. .... ...... Type of Construction ...Fr.ame................................. ...... ................................................................................ Plot ............................ Lot ................................. Permit Granted .. ..................19 84 .. ..... .... Date of Inspection ....................................19 Date Completed ......................................19 a-� Asses"sors map and lot number FINE Sewage Permit number ..0....�.../ .........1..�..lof ........ . 'y r r,W o �-L • '�� �� j Z BAHBSTADLE, i House. number ....... .70.................................................:... rasa ,�� s t639- 0 NA d' TOWN . OF BARNST�ABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..... /.. ...Z?.......... U�`��....................................................................... I TYPE OF CONSTRUCTION ................lrt�.O.d.D... /�'! l�r ........7!�X(,A........................................................... ................. � ..7.................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .......................JV....7....... hls.tic.ICI!Y`�C•1..Drr.....1...( ...Ni 15..................................................... Proposed Use ani.. A0YN: -........ Zoning District ly/f.........................................Fire District �F'I�i�4'!�1.� ..:Os�erv;�l. .. j......... Name of Owners-.v.y-.a1.....!!!!.k..!4UV..ITQQV.1..................Address ?Vv-s..... Name of Builder ......J..'kWA....(tUY.. Uh.7...� ...........Address .....................5!}l! :�........................................... Nameof Architect ..................................................................Address ....................................................................................... Number of Rooms .......,.....0•..................................................Foundation .P.Mte -..... ........................... , 4' Al"� ��'. � � t ( Roofing .....a. jo�t l ...0 61yt.5. 18.. ' Exterior .... ..... t� . . ....: ..... . .. ?��....... . ..................................... Floors .....D.......f. v.4-1................Interior ....s�� r�/ I�............................................................. Heating .. .. . .. ... ... .......�. ................ .! ........................Plumbing ...... ..�... ...........C.. ..�. ............................ L � Fireplace r���. t.�j�Q.GJ ........, ...T.Ill.5.....................Approximate. Cost .....7�!O�. ........ ,..... Definitive Plan Approved by Planning Board -----------_------_-----------19________. Area ...........`7�.................. Diagram of Lot and Building with Dimensions Fee ?ell.......... ......... SUBJECT TO APPROVAL OF BOARD OF HEALTH .4 c t q i 3y 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 1-R,........ ........................ Construction Supervisor's Licenseob�s.-I.q................ .HUNTOO,N, STEVEN W. .2L287..... Permit for J�2...��qr..Y................ Single Farni4..p�q4,1�cj....................... .............. ................ L. Location Lot 7,..._.170...Whi.s.tl!��....Drive .. . ...... . .... ... Marstons Mills ............................................................................... Owner S.teven..W.....Hurito.on......................... . .. ........... .. ........... .... Type of Construction YK ............................. ................................................................................ Plot ............................ Lot ................................ Permit Granted April...11.......................1�9 84 Date of Ins c i A�an ....... .....:19 DateCIO ......................................19 iw fr TOWN OF BARNST�,BLE 26287 , Permit No. ------ -- - — - - Building Inspector Cash OCCUPANCY PERMIT Bond _ X___- Issued to Steven W. Hp6toM , Address Lot 7, 170-%dstleberrX Drive, Marstcns Mills Wiring Inspector Inspection date Plumbing Inspectors Inspection date . ' ` v �Gas Inspector ��`` Inspection date Engineering Department Inspection date Board of health /'t !f{ �-�- i Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIILEMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ............ 6� i �.,� Building Inspector M 1„ m'�y��•. TOWN OF BARNSTABLE BUILDING DEPARTMENT = sesasr = TOWN OFFICE BUILDING rua i0J9. � HYANNIS, MASS. 02601 env MEMO TO: Town Clerk FROM: Building Department DATE: An. Occupancy Permit has been issued for the building authorized by Building`Permit #.......� a. .. ............. ....................�................................_.................._........................ „ .__. issued .to ..._._...._...... .�.........................._........._.._. .. ? Please release the performance bond. Z 2.5. OD 11F l O 7 - '' a 3 , Sob = co Lid 101 7-L A a 144 . 47 45 e LOf.�iT/O.V: BQQ�-5 ABLE 3CAL I 44O 9164 ,2 E:, I?•F I aL L o7 7 A 5 S F-lOti1�, i i,-J VL4KJ E3JO►C .. 34� DaGE 55 �V 2 /-��CL"BY CG'L�T/FY 7,",QT SNOH/�t/ O.V rN/S .pL q.�/ /S LOG.gTED O.V T.NE ., /��� ,. ,•,,, 4qtOu c/D oQS .3NO Wn./ NB6&CkA/ !-i,t/D TNgT /T 170IE5 Cp.vFOG.1�! TO T/�e 2o.c//.VG BY-LAWS of r.�/E Tt�w.v oft�2r.1n�t_E f O!mac/ Lt/ L L &/�e , /r,C. e 9 / 98 n.4rr W, Vodow S L yj rl o `tee 1l0�a G - n .• g? 0\7- �ah ALicj—Ea — — 'a d N1 o 77 3�u,Sk��4 bwz Fbe.;,� L;,,{ _ S ��o P.k, Ct�'�c•,o�.an. �e�� ' . l� So�llt� .0�G° ° �v�e� 0 '\ . .1@V. 4 _ kQ EPr•r ����� = o y / 6ll �06`\1.,C '1`'�. �' c Qr�C .,Otx:� /� C 1 C 9 6 p f�.'8 0 _ _ ��ts.3•:�, �` Cc,� , C o"c Es �� a �- 1.Y,OSS J�\UN b C.t.. � � C7b►.e•�� fS �O U. „L.L �=