Loading...
HomeMy WebLinkAbout0064 WILLIMANTIC DRIVE ACTIVE Town of Barnstable Permit# Expires 6 months from issue date Regulatory Services Fee s— r • )ABNSTABIM • v HAM Richard V.Scali,Interim Director 039, Building Division � Tom Perry,CBO,Building Commissioit'eY-PRFS8 IRF 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us OCT 19 2015 Office: 508-862-4038 ,� � r Flax-: 508-790-6230 — EXPRESS PERMIT APPLICATION — RESIDE1VlAL ' Not Valid without Red X-Press Imprint Map/parcel Number 105 O SS Property`Address (y ct/,'l l„rt�t n f i �A/C�o t1 S A 1.l S 2 (Residential Value of Work$ 3 92 Z — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 'a_rdky t/G i. Aars4ans diffit tjA QZ&41 1BIK[R4) Contractor's Name [ t0.S /Sol✓ Telephone Number -ILr— Home Improvement Contractor License#(if applicable) 7,32- Email: Construction Supervisor's License#(if applicable) O S74 7 AWorkinan's Compensation Insurance Check one: f0.-I'am-a sole proprietor ; I am the Homeowner .I have Worker's Compensation Insurance Insurance Company Name Q NAW_ l�S (.flirt 9N 7 Workman's Comp.Policy# ule__Qagog3 0-7397 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 AO (maximum .35)#of windows_L #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Wheie 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 required. SIGNATURE: QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 IMMewal. Agreement Document and Payment Terms I NAMwen J&m%mcwal l3vAnderienofSomilcm;Nc.wEngl�d Dwathw Ova teog!M-me-SwYwn New UVWd Ve*Yr-&ILLC :64WNimanbc Di Pi,9. Maiston WIS.N 36079.-MA*1732-45,CT MOMS% Lead FIrm#123.7 U550264U N Abcn W I brioYrt,M 02865 F,-(i0B)428-S5�2 #,cm- 563.22351 Pacloi-6334«12 I sa1_ncrenevmlsnexm cfs"61-550 10 )1 Cii-waffm-niji) Njje,&- b0r0t`bV SHV3 004116 Ciuwfliie (t)Sviteu Addyeuz..64 WilliMakitk Dr* MM"MR00 M-HIS , WS5026" lbuyub)her6v j0i.ndy ar;d!scvmUy ag grets up pliuchast the producis andlor selridm afSnu.&m �tew EngW'qTJjn&nrsJIC d-Na Pwim-fttal A By rsdersciii of SuAtm Ne-w UgUad("Coutram,'.).'Lit;weardww-c wttlt tht tumuzibil owididoca&ser-Ibled' bb flItIs Agrreft'llclad Domment ind Nyuncow,Tffp&Nmcc Of C9jtC,9Ija9jOnL.l'ZMj7Crgl ONIfr Rbwipi,Tcui s andCondifinins al'S&Saks C Mm Savi mv Pnogram (SCSK Lead-Sak, Num(CTI ,& ?MALIm'porcum and any odw docu nacint wxacfA co.this Agrecrium Documxmw the unm of which are all'ag!7etE um k r y ihe F is clampletedall fq�n a-CoMpLetion.cmd6me er i ahnctor vvvwb uls'der c 'row 16"iflattiw $31992 Icy sl�vvingodiis agpimment,yni Li:xknezWou that tkc NbnM Duc,,md&.C.A-Matrilit Depodii Rim-tiviA 10,26 Da: Awit"t Finafici-A Meiihad of Wc S-CbWUk IAIStd-121i GF115'timed on dwduc Ot[he AVDW COW=and socudadly oa t6e.date 6 w4t:idlt we cumplatz the itxiani®I Meusumwnzutl�_The im" abate te dia Nwitt GS d'ejowit:$199-1 this time onblancytimaTe.We Twill cam municaman official c1leEC Balance.S 1991 and flint at*Utet date.. Utt dwiftou Cumbribon egumb for Taxes Barnstable dela3t guyu(,)agrecs and undemart4s dmE this AgCC0WWC0nSdW1CS I he enEiYC UR&PA-Andutr Aw pbe CeflEbepwiiesmd,'duiEherearer*,%xiU U24CIISUnd dlfi',CIVAh8IR$;01 Milediryki.:g illy OF LIW 0MIM orcix,s AgItemiluic No almwkym to at devi;m3otis from JAs AgrunimtE 5in11 be v-dIJ wiqhoui chesigmd,wricunicarmm, of both rhe:BirycrO.and Conmcrior, Blqw(s)ha* 0 has reld tbb Agremcni,uadearands 6t sedans of thl's AVocnit.ne,and has Feceived a compkicii deal, amd duca.copy*of thi-s.AgoemcnE,including, the seep zinciled Not of CancellZT10M.,on the&te fim%NIFJ I iten Ax vve and_)w=anfly intarmad of Burs-i"t to C20Cd Chi;;. AgFeaM,ML N - _ltu Al(M.C E��Iro 0 WN EA: Diu Lb sk 131)it e if'&6i IL V -e inuided Cat Copy fif Lhe Obitteact at 16 I'libit vw A'Lrib. YOU,THE BUYER, N MY CANCEL TUTS TRAM SACTI 0 N AT ANNY TIC:NOT LALTI E R THAN.MI MIGHT OF 1010712016 ORTME THIRD BUSINESS DAY8FT I ERTHEDATE OF THIS MANSACTIOIN) WHIC HIEVER DATIE IS LAML SEE TFIE)UTACHED NOT WE OF CANCELLATION F'0_ PUN-1 FOR AN M'LANWIICIN OF THIIS RIGWIC. Nurio Suirt6m.Hum En:ia�Vwdww3,ULC CcAucKsw W, James col'ageo Dorothy sliva Pcint Name of&-16 Nrscjs-ll Print Nin-It Print N-3jult Fa4e 4 ID f I ' Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-095707 construction Supervisor BRIAN D DENNISON 7 LAMBS POND CIRCLE CHARLTON MA 01507 �...v� Expiration: Commissioner 09/0812018 d e �YyLfjLC�ncceccff`r, c����cucc�ccle Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite D-170 Boston, Massachusetts 02116 Home Improvement.Cortractor Registration _ _ = Replstratlon: 173245 Type: Supplement Card Expiration: 9/19I201 B SOUTHERN NEW ENGLAND WINDOb)VSdLL-A BRIAN DENNISON =! = `- 26 ALBION RD LINCOLN,RI 02865 � = _ • Uodnte Address and return card.Mark reason for change. sra i :; zoMasnt F-I Address ❑Renewal J Employment Lost Card Jac�rnrn.wrrnnn�V.r�y��:urrr�u;.1L4' I ""^\_ f8ce nr Cnosumer:Utairs&8usiocss Reaul Non Registration valid for individual use only before the r7 expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration:.1hN5, Type: 10 Park Plaza-Suite 5190 Expiradan:."9/.1gnals Supplement Card Boston,LLA 021.16 SOUTHERN NEW ENGLAND-WINDOWS U.C. RENEWAL AL BY ANDERSON' - BRIAN DENNISON 26 ALBION RD LINCOLN.RI 02865 �.Uhdcrsecret�ry~ Not valid without signature i i a � The Commonwealth of Massachitsetts 63, Department of Industrial Accidents 1 Congress Street, Stcite 100 -� Boston, 14 02114-2017 --.. is i-. P wwfv.mass.gov/dia Wgrafters' Compensation insurance affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED'Y41TH THE PER UTTING AUTHORITY. Applicant Information A Please Print LeRiblr vari2e (Business/Organization individual): d t 1 ti�i1 ,�� � �A, ��I Ni��.DW .address: City/State/Zip: f Phone=: -1 2-Z L�� Are ypu an employer'.'Check thee�appropriate hose Type Of project(required): i. i am a emolover with '2{J#emplovees(full and/or part-time)." ]. [J—New construction Z.�I am a Ole proprietor or partnership and have no entplayces working for me in $. �Remodeling any capacity.[\o workers comp.uisurance required.I 9. ❑Demolition 3.❑I am a homeowner doing all work myself:f No work66Tf—comp.insz.irance required.] IO Q Building addition -..❑I am a homeowner and will b_hiring contractors to conduct all:work on my uropt:M.. I will ensure that all contractors either have worker'compensation insurance or arc sole i 1.❑ Electrical repairs or additions proprietor:with no emnlo_:ees. 12.lf-�Plumbing repairs or additions 5.17 1 am a general contractor and I have hired the iub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have v:orkers'comp.insurance. 11. Other 6.❑*%Ve are a corporation and its officers have exercised their rigbt of exemption per N401-c. i5',§I(,),and%ve have no employees.(No workers*carp.insurance required.) �P�(d�G•.enr Any applicant that checks box=1 mutt also till out the section bclo-showing their vrorkers'compensation policy ininrmetion. r Hnmcowner>who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such- :Cann—actors hat check this box must attached an additional sheet showing the name oFthe sub-contractors and;rate whether nr not those entities have employees If the sub-contractors have ernployets they must provide their workers-comp.policy number. B I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site informatioat. Insurance Company Name: ��!' /� if�d{� ��") ' Policy 1 or Self-ins.Lic. �A 3 13 6a OAF r Expiration Date: Job Site Address: l q 1l/,-l1r1nQ�flC JJr. City/State/ZipYY7&r_s o✓ts ; �s A Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under;vlGL c. 152,§25A is a criminal viol ad on-punishable by a fine up to S1,500.00 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 copv of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverage verification. l do hereby cer ' • ruder thepRia is and penalties of perjury•that the information provided above is true and correct. _ fl jt Signature: Date: 0 Phone Y: Official use only. Do not write in this area,ro be completed by city or tower official. City or Town: Permit/License R 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#r: i SOUTNEW-01 UOLLINGER DATE(MMIDO/YYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 6/29/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSl�TTUTE A CONTRACT BETWEEN THE.ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE.CERTIFICATE HOLDER IIMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.if SUBROGATION IS WAIVED,subject to the terns and conditions of'the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder it lieu of such endorsement(s). CONTACT PRODUCER NAME: CoBiz Insurance,Inc.-CO INC. ;(303)988-0446 No :(303)988-0804 821 17th St ac No. Denver,CO 80202 DRESS,CqBiilnsurance@qobizinsurance.com INSU AFFORDING COVERAGE NAIC# INSURER A:Continental Western Insurance Company 110804 INSURED INSURER H: Southern New England Windows LLC INSURER c: DB/A Renewal by Andersen INSURER D 26 Albion Road Lincoln,RI 02866 INSURER= I i INSURERF 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. IN SR POLI EFF I.M DCY Ew. LIMITS TR TYPE OF INSURANCE. I.. WVD POIJCY NUMBER D X COMMERCIAL GENERAL LIABILITYii ( 1 1 1 EACH OCCURRENCE 5 1,000,00 CLAIMS-MADE OCCUR ; 1 CPA3136080 1 07101/2016I 07/01/2017 i PREMISES Eaommenoe 5 1.00,00 I ! 1 1 1 MED EXP(Any one person) S 10,000 1 1 1 1 PERSONAL BADVINJURY I S 1,000,000 1 I I GENERAL AGGREGATE S 7r000,00 GEN'L AGGREGATE LIMIT APPLIES PER: 1 PRODUCTS-COMP/OP AGG is 2,000,000 j POLICY JET ( Loc I EMPLOYEE BENEFI 1 5 2,000,.000 —I OTHER: AUTOMOBILE LIABILITY COMBINED SINGLc LIMIT I I i Eaacadem 1 S 1,000,00 A 3C '�ANYAUTO I 1CPA3136080 1 07101/2016107I01/20171,30DILYINJURY(Perperson) I5 ALLOOWNED 1 11 SCHEDULED i I I ' f BODILY IN (Per accident) S !�I NON-OWNEDt ( ! i f PROPERTY DAMAGE g ' I Per xadeM HIRED AUTOS AUTOS I X UMBRELLA LIAR ix OCCUR j EACH OCCURRENCE Is 5,000,000 A EXCESS I" CLAIMS-MADEI CPA3136080 j 07101/2016 I OT/01/2017 AGGREGATE S DED X RETENTION S 0I I I Aggregate 15 5,f?00,00 1 WORKERRS COMPENSATION I I STATUTE ( 1 ERA IAND EMPLOYERS'LIABILITY y1 N 1 1WC I E.L.EACH ACCIDENT S 1,000,000 A ANY PROPRIETOR/PARTNER/DCECUTIVE ❑ N/A A3136061 07/01/20 6 OT/0112017OFFICERIMEMBER EXCLUDED? I I 1,000 000 (Mandatory In NH) I I i 1 E.L.DISEASE-EA EMPLOYE 5 + (Mend describe under E.L.DISEASE-POLICY LIMIT 1 S 1,000,000 DESCRIPTION OF OPERATIONS belay DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H 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 R E EPRESENTATIVE ©1.988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i //!o/DL`'iTY /1/�tG�f/gO��e �U�5�Gc�rE ��� �-� C'v u�-r•�rr � ��� 9 Building Division ' {' 200 Main Street ' Hyannis, AM 02601 7012 1010 0000 2850 9828 . - _ „ . _ . . - - .. .. „-. __ v�. .r-.. • . mot;. _ rf" r _ Dorothy Silva 64 Willimantic Drive Marstons Mills, MA 02648 —( ,• SECTIONCOMPLETE THIS ON DELIVERY 4'SENDER: COMPLETE THIS SECTION I '■ Complete items 1,2,and 3.Also complete A. Signature ❑Agent I item 4 if Restricted Delivery Is desired. ❑Addressee I X I ■ Print your name and address on the reverse I I so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery I I ■ Attach this card to the back of the mailplece, I I or on the front if space permits. I D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No I G� I l an . h�n I I 77&w"4 7"A 3. Service Type I )&Certifled Mall O Express Mail I I Zc!Y 13 Registered Return Receipt for Merchandise 7770 p Insured Mail ❑C.O.D. , I 4. Restricted Delivery?(Extra Fee) ❑Yes I 12. Article Number 7012 1010 0000 2850 9828 I (Transfer from service i PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-154o,� C NAME 01 OFF y .... BAR 74599 TOWN OF ADDRESS !!` R CITY.STATE.Z CODE f i� f^y , f! %' j j� ` BARNSTABLE NUMBERt p 0 1 MV/MB REGISTRATION NUMBER OFFENSE r, 1639 P 0— W TIME AND DATE OF VIOLATION _f - LOCATION Of VIOLATION �7rf _ + ,r w iNOTICE OF (A.M./ P.M.)ON ,2U.1 / 1 G / J VIOLATION SIGNATURE OF ENFORCING PERSON ENFORCING DEPT, ( BADGE NO. Cn 2 I OF TOWN I HEREBY ACKNOWLEDGE RECEIPT OF CITATION XLU II ORDINANCE Unable to obtain signature of offender. I THE NONCRIMINAL FINE FOR THIS OFFENSE IS Z Date mailed Lw OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL I DISPOSITION WITH NO RESULTING CRIMINAL RECORD. LLJ IREGULATION 11 You may elect to a the above fine,either b appearing in Q 1 ( ) y pay y pp g person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, W I before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. n- (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature i TO OFFENDER: Failure to obey this notice within 21 days Place i after the date of violation may result in a Stamp j criminal complaint being issued. DO NOT Here MAIL CASH. Post office will not deliver without stamp I of i I MAIL TO: ' J BARNSTABLE CLERK P.O. BOX 2430 0 HYANNIS, MA 02601-2430 ' I. I . - I U.S. Postal ServiceTM . CERTIFIED MAILTM RECEIPT (Domestic Mail Only;No Insurance.Coverage Provided) '• For delivery information visit our website at www.usps.come or(WO Lrl CO Postage ru Certified Fee M Return Receipt Fee Here C3 (Endorsement Required) M Restricted Delive'F e77 (Endorsement R.quiZr) ru ,. ---------------------- city State,ZIP+4 PS Form 3800;August 2006 See Reverse for Instructions Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mails or Priority Mails. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". in If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 mot fated. I � �3 PROJECT NAME: . ADDRESS: Log , ( ( t w\ov%-k De- It PERMIT# PERMIT DATE: .. LARGE DOLLED PLANS ARE IN: Z . SLOT - Data entered in MAPS program on: J q/wpfdes/forms/archive Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 11/11/4 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for 64 Willimantic Drive (#B 2014741) has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey NOISIA10 t1 Gi Nd 1 A;,� ttit, �78d1SN�ds �47.►'VT�,OI - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � Map 3 Parcel 10E6 Application # [eq Health Division Date Issued v 4a) Conservation Division Application Fee J Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ov Historic - OKH _ Preservation / Hyannis Project Street Address r Village . r t Owner o %1 Address SaM Telephone So Permit Request R�1 "�y Je&Z P&r, Lei Ce lk L Q f• Rl.� 13 ceI It.lost +0 -ILe K141�c. t �ir Sck ±ke G ILA8 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 3 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review # Current Use Proposed Use TEO-, WU _T,; APPLICANT INFORMATION (BUILDER OR HOMEOWNER) -� p 8 ��9� 03 q8 Name, e_Tele hone Number Address6- _ - License # '2�L Iox -W Home Improvement Contractor# ITI 0 Worker's Compensation # bJWG 33 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 .rtaAk4 ► I SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. I. � ADDRES S VILLAGE OWNER Ir DATE OF INSPECTION: :i,FOUNDATI FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING' s _ s .DATE CLOSED OUT ASSOCIATION PLAN NO. tdfb op rancimm mass save cooffimm PERMIT AUTHORIZATION FORM I, owner of the property located at: (Own ame,printed) /A #r"4& (Property Street Address) (City/rown) hereby authorize the Mass Save Home Energy Seniices Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on m roperty. OwneftSpature Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Rev.12132011 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 '�'I��:.i-'-'.:ice..=_•^-.. Boston,MA 02114-201 7 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Busincss/Organizationllndividuai): Cape Save Inc. Address: 7D Huntington Ave City/State/Zip: South Yarmouth. MA 02664 Phone#: 508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓❑ 1 am a employer with 4. ❑ I am a general contractor and 1 6. ❑,New construction employees(full and/or part-time)." have hired the sub-contractors. -sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling 2.❑ I am a ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. employees and have workers' ' y P tY 9. [] Building addition [No workers'comp.insurance comp.insurance.? required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other Insulation comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy hilormation. t.Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp:policy number. 1 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Wesco Insurance Company Policy#or Self-ins.Lic.#: -WWC3085633 Expiration'Date: 04/09/2015 M t 1M — 1�- Job Site Address: 6 1 W l I ; i C I r, v P. City/State/Zip: I lGrot n S I 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 S 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$250.00 a day against the violator. Be advised that copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage verification: I do hereby certi under the pains and penalties ofper that the infforinalion provided above is true and correct Sianature: Date 3 t Phone#: 50$-398-039$ r 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#: ® DATEIMMIDDIYYYY) , '4� CERTIFICATE OF LIABILITY INSURANCE 4/14/2014 1 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(fes)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 endorsements. PRODUCER CONTACT NAME:. Colleen Crowley Risk strategies Coupany PHONE (781)986-4400 AID No:(761)963-4420 15 Pacella Park Drive Appp ,Ess.ccrowley@risk-strategies.com Suite 240 INSURERS AFFORDING COVERAGE NAIC f Randolph MA 02368 iNsuRERA:Seleative Ins. of America INSURED INSURERB-Safety Insurance CcmpanV 33618 Cape Save, Inc iNsuRERC Wesco Insurance Company 7 D Huntington Ave INSURERD: INSURER E: South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1441475243 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. �TR TYPE OF INSURANCE .POLICY NUMBER MMIDO YY MMIDO EXP LIMITS GENERAL.LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES fEa occurrence $ 100,000 A CLAIMSdMADE Fx�OCCUR S1994480 0/16/2013 0/16/2014 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 j GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO X LOC $ AUTOMOBILE LIABILITY COMBINED Ea accident)SINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 6208200 1/6/2013 1/6/2014 .AUTOS IX AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS AUTOS Pere dent X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,060,000 DED RETENTION es 1994480 0/16/2013 0/16/2014 C WORKERS COMPENSATION Officers Included For X WLSTATU- OTH- AND EMPLOYERS*LIABILITY R ANY PROPRIETORIPARTNERIEXECUTIVE YIN T overage OFFICER/MEMBEREXCLUDED? N❑ NIA E:L.EACHACCIDENT _ $ 500 000 (Mandatory In NH) 3085633 /9/2014 /9/2015 EL.DISEASE-EAEMPLOYE $ 500,000 I(yes•describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LPd1T $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space Is required) Issued as evidence of insurance. Issued as evidence of .insurance. Thielsch Engineering, Inc. is listed as additional insured as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION msong@capelightcompact.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, N0710E WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Margaret Song PO BOX 427/SCH AUTHORIZED REPRESENTATIVE 3195 Main Street Barnstable, MA 02630 �� chael Christian/CLC ACORD 25(2010/05) 0 1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD r Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. _ WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 mry� Update Address and return card.Mark reason for change. sen t Co 20M-05/11 Address ❑ Renewal Employment Lost Card vize�ane�nn�tweml!/o��-� /r'u.1:Jar�r�.ret13 �t . Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 171380 Type: Office of Consumer Affairs and Business Regulation j Expiration: 3114/2016 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE 4 iLc o SOUTH YARMOUTH,MA 02664 Undersecretary Not vali rthout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor Specialty License: CSSL-102776 ,N ti1 I I, b ; �= WILLIAM J MC 4%US 37 NAUSET ROAD s West Yarmouth MA 02 IN Expiration Commissioner 06/28/2015 / TOWN OF BARNSTABLE Building ' 201303960 BARNSTABLE, Issue Date: 06/25/13 Permit 9 MASS. 1639� �� Applicant: SILVA,NESTOR&DOROTHY TRS Permit Number: B 20131482 Proposed Use: SINGLE FAMILY HOME Expiration Date: 12/23/13 Location 64 WILLIMANTIC DRIVE Zoning District RF Permit Type: RES STORAGE/LIVE IN TRAILERS Map Parcel 103055 Permit Fee$ 25.00 Contractor PROPERTY OWNER Village MARSTONS MILLS App Fee$ License Num Est Construction Cost$ 0 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND LIVE IN TRAILER-6/14-7/3/2013 THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: SILVA,NESTOR&DOROTHY TRS BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 64 WILLIMANTIC DRIVE INSPECTION HAS BEEN MADE. MARSTONS MILLS,MA 02648 Application Entered by: RM Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.SHEATHING INSPECTION 3.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 4.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 5.PRIOR TO COVERING STRUCTURAL MEMBERS(FRAME INSPECTION). 6.INSULATION. 7.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). POST THIS CARD SO THAT i BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health NAME OF-OFFEND BAR 74599 TOWNyOF ADDRESS Ofjll FE_ v R U) t 1) BARNS`fABLE CITY,STATE lk�^�d�� ! t} ��,J OFF SE �' - .03V• ecte- > TIME•AND DATEAF VIOLAT�I N" /!- L"9 ION OF VIOLAT N, Z NOTICE OF I -�A.M�i�P.M.)ON V( .2. ( 1�t <tr1` SIGNAtURE OF,E,N,FOGrG P@RSON ACING DEVT. BADGE NO. LQIJ VIOLATION TO �:� OF TOWN I HEREBY'ACKNOW_LE E R/OFION Xii ORDINANCE �Unable to obtai Sig attire� , THE NONCRIMINAL F FOR THIS OFFENSE IS i ��'Date mailed wOR YOU HAVE THE FOLLOWING ALTERNATO DISPOSITION OF THIS MATTER.EITHER TION(1)OR OPTION(2)WILL OPERATE AS A FINAL DISPOSITION WITH NO RESULTING CR Uj REGULATION a (1)You may elect to pay the fine,either by appearing in person between 8:30 A.M.end 4:00 P.M.,M through Friday,legal holidays excepted, ry before:The Barnstable Clerk, Main Street,Hyannis,MA 02601,or by mailing a check,money order or note to Barnstable Clerk,P. Box 2430, I Hyannis,MA 02601,WITHI NTY-0NE(21)DAYS OF THE DATE OF THIS NOTICE. (2)If you desire to come this matter in a noncriminal proceekL'rlg,you maeyy do so by maldng written request to DI CT COURT DEPARTMENT,FIRST BARNSTABU DIVIS COURT COMPOUND,MAI STREET ARNSTABLE,MA 02630,Attn:21 Noncriminal arings and enclose a copy of this I citation for a hearing. . r ' (3)If you fall to pay the above offense or to request a hearing within 21 days,or N you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be Issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense.charged,and enclose pigment in the amount of$ Signature T NAME OFVJK00ER BAR 74599 I TOWN OF ADDRESS OFF N EP 1 i BARNSTABLE CITY.STAT E =_ U MWMB REGISTRATION NUMB �1XE rq _ ' - 1•� 0 EN ///••• LU -_ HAX\.'1'ANIY.. 0 CL, — IOyp. �� J r'a MR+� 10, � ! I - D T OF VIO T 20 ION OF ID;TI N` LU NOTICE OF �( •M• _ .)0 - J _ SIN 0 FORCI N E IN D T. ADGE NO. N I VIOLATION OF TOWN I H Y ACKNOWL RECEIPT OF CITATION X w a ' I Unable to ob sig a e o nder. ORDINANCE ` THE NONCRIMINAL FINE FOR THIS OFFENSE IS S W Date mailed w OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL w DISPOSITION WITH NO RESULTING CRIMINAL RECORD. Q ' R CGU LAT 10 N (1)You may elect to pay the above fine,either by appearM in person beetween mailing 8:30 A.M.and 4:0o P.M.,Monday through Friday,legal holidays excepted, LU I 1 Hyannis, arnstabWITHIN Clerk,TWENTY-ONE(2H)DAYS OF THEDATE OF THIS a check, money order or postal note to Barnstable Clerk,P.O.Box 2430, d - TIf you desire to contest this matter-in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST RNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this I ; citation for a hearing. - (3)If you fail to pay the above offense or to request a hearing within 21 days,or•d you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ — — Signature .f 1 i . i i r n� Town of Barnstable TOWN OF BARNSTABLE ,�Ft"E'Owti Regulatory Services 10I3 JUN 1 2- AM 10: 33 Thomas F. Geiler;Director B" MASS. ' Building Division m i6Sq. � 0tfp MP.'a m Tom Perry Building Comissioner 200 Main Street, Hyannis,MA 02601 DIVISION Office: 508-862-4038 Fax: 508-790-6230 COMPLAINVINQUIRY REPORT Date: Rec'd by: /Parcel / �S Complaint Name: Ma p _ � 5 Location Address: /~ / a A192 Originator Name: ,it�1011 Street: Village: State; Zip:. Telephone: Complaint Description: e. i I/i �Q/Y?EWA -n FOR OFFICE USE ONLY Inspector's Action/Comments Date: Inspector: y Mo 1 Additional Info.Attached TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel d plication # a�. 3 _ 0� �ARPdSTA��� = 2S �_HealthTDivision -. - Date Issued l Conservation Divisions ton JUN 17 21 11App iication Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis ®IVIS O�y Project Street Address ,�/� yLl�ly Village AX, Ol ner f ' `� t Address Teirphone 5OP�mit Request i�1+�►" �� �� 2 _ v 0 0 wA) rp4 v-P7 l LY 2 Li Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project=Valu`ation G Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑ Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use _ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) me Telephone Number ,:5'o7= 7 z Address blC��,OD�t e.�� License # V Y`����lJ `�s e"`� (f �/'"✓� o�� Home Improvement Contractor# f- Worker's Compensation # ALL CONSTRUC ON DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 N SIGNATU DATE ( FOR OFFICIAL USE ONLY ' APPLICATION# } �t • ;; DATA ISSUED . G} .Y MAP/PARCEL NO. rti ADDRESS �•J VILLAGE • . - E OWNER ; k DATE OF INSPECTION: , UfFO.UNDA-T-',[ r - FRAME >r 4;INSULATIONA+P:M,-tal ,A ws uut i:., f FIREPLACE ' ELECTRICALr ,ROUGH FINAL - r rPLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING'". - DATE CLOSED,OUT ASSOCIATION.PLAN NO: 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 Applicant Information Please Print Legibly Nam, (Business/Organization/Individual). (� Address: tSq ��(•1ir�N/, ��/Z City/State/Zip: S S Phone#: Sae— r5 9 a CAre you an employer?Check the appropriate box: Type of project(required): 1.El am a employer with 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7: ❑Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.# re ed.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. a homeowner 4e3ng-a})•wvrk officers have exercised their 11.❑Plumbing repairs or additions right of exemption per MGL 12.❑Roof repairs �ncitranr P*Pn�;,* t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is 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$1,50D.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. J do hereby certify under the p 'ns d p naid of perjury that the information provided abov is tru and correct. Si a e: Date: 13 rr one#: t 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#: .Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any. applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of . insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should, be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license 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. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,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-NIASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia > Town of Barnstable Regulatory Services snartsr"i MAM = Thomas F.Geiler,Director 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 HOMEOWNER LICENSE EXEMPTION Please Print D'ATE: JOB LOCATION: number street village "HOMEOWNER �� t I name home phone# work phone# 1 " .CURRENT MAILING ADDRESS: < V � 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 inspection ce and require en an at he/she will comply with said procedures and requirements. ign of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);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 be/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C,:\Users\decollik\AppData\Local\Microsoft\Windows\Temponuy Intemet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doc Revised 053012 ' 1 T Town of Barnstable Regulatory Services IARMST" E, + MASS Thomas F.Geiler,Director i6.19. pTEn�•�'' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnsta6le.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit. (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed.and accepted. Signature of Owner Signature of Applicant i Print Name Print Name Date QYORM&OWNERPERMISSIONPOOLS 62012 Town of Barnstable Geographic Information System June 17,2013 40- 103062 _: 103054 103135 #33 l 103055 #64 103061 r P #63 a v 1#a1s tv e- 103056 NEW HAVEN AVE #76 Feet 103060 #79 103137 � #61 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:103 Parcel:055 boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcei,Owner:SILVA NESTOR&DOROTHY TRS Total Assessed Value:$270900 1'=100'may not meet established map accuracy standards. The parcel lines on this map WE E are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner:NESTOR G SILVA TRUST Acreage:0.48 acres Abutters . boundaries and do not represent accurate relationships to physical features on the map Location:64 WILLIMANTIC DRIVE ' such as building locations. Buffer /�� i Cape Save Inc. TOWS ®F ������� 7-D Huntington Avenue $LF South Yarmouth, MA 02664 2013 jypl 21 P�T1 1' �3 Tel: 508-398-0398 Fax: 508-398-0399 DIarSIO 06/21/13 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 210 Willimantic Drive,Marstons Mills has been inspected by a certified Building Performance Institute(BPI) Inspector. Ceiling: R-19 cellulose Floor: R-19 fiberglass blanket All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey Crystal Reports Viewer Page 1 of 2 JJ 4 4 ➢ V I1 / 1 Imainikeport I ih 1007 .w ausige ctv _ 8/28/2008 Town of Barnstable Issued Permits - Contractor Name Date Range: 1/1/2000 - 7/31/2008 RONALDFREGEAU Application# Status Parcel Street Village Permit Type Issue Date 45060 C 247208 110 CLIFTON LANE CENT RADD 3/28/2000 52773 C' 147067 41 ENSIGN ROAD CENT RADD 4/13/2001 54238 A 122150` — 46 SHARON CIRCLE;_ OST RADD 6/29/2001 55732 C 124022001 533 OLD FALMOUTH ROAD MM EXP 9/10/2001 60153 C A 1,03055` _64_1NILLIMANTIC DRIVE MM MISC 4/4/2002 64224 C 248171 40 ELLIOTT ROAD CENT RADD 10/3/2002 68499 C 227099 166 HARBOR HILLS ROAD CENT RADD 5/2/2003 69588 C 146118 69 RENOIR DRIVE OST RADD 6/19/2003 71661310055 - --.-91 BAXTER'ROAD=--j HYAN RADD 9/19/2003 71700 C 308048 674 MAIN STREET(HYANNIS) HYAN CADD 9/22/2003 72071 C 099018 20 CAMMETT WAY MM RADD 10/7/2003 75326 C 226126 46 JACKSON AVENUE CENT RADD 3/15/2004 78373 C 226125 73 CENTERVILLE AVENUE CENT RADD 8/5/2004 Total Permits Issued: 13 I littp://isdomain/businessobjects/enterprise115/infoview/Report/report_view_dhtml.aspx?id=7879&dpi=96 8/28/2008 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �} Parcel Permit# �o _ �-- Health Division Date Issued Conservation Division n 3 Jisy Imz, Fee Tax Collector IIV _ C ''�� �� s, IN carTpLlld�i+� A Treasurer THE 5 Planning Dept. ; . Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address n¢ LQ I t IIII f A td"I-fi C 1-I u-2 Village _AAAA6-moi S Owner h1=e,5Tng A Dne b rh -q (� I V q Address /tA Wi Ill mr4m tc, D t- Telephone Permit Request N 5'r i-LI L T lq a^4 R a-<o s � . Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation (713,, no Zoning District Flood Plain Groundwater Overlay Construction Type UJCC 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 O No On Old King's Highway: ❑Yes ❑ No (� 1 Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other i Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing ? new -0Z_ VZZ Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other 2 Central Air: Cl 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 Clnew size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded Cl Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Namega N l� D S 3�enN Telephone Number ( 609 4H Address I RR Ti m b-p—I- �aN-e. License# D�-366 kmz.sIm tq _AA c l I_S . .,4 Dar.4-R Home Improvement Contractor# Worker's Compensation# (A)C V ti�CM 766 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �l/� -rna��t_G> (�c s;�asw SIGNATURE DATE 1 , rUO�- 4 FOR OFFICIAL USE ONLY 'PERMIT NO. DATE ISSUED MAP/PARCEL NO. i ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH - FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i The Town of Barnstable Regulatory Services Thomas F. Geiler, Director Building Division Peter F. DiMatteo, 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 e. 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: (,,wst'Kicr a r 1- Gnk•r)-6e_ Estimated Cost 3 � Address of Work: 64- UJ L 11 A4011M C D�i u-e Owner's Name:140fl-n. S i l u o Date of Application:�N I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded bylaw ❑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 ent of the own 0�— Date ctor Name Registration No. OR q:forms:Affidav :rev-122001 f �pF THE Tp� • ansuvsTnai.e, 9 MASS' i639 Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 July 26, 2004 Ronald Fregeau 188 Timber Lane Marstons Mills, MA 02648 RE: 64 Willimantic Drive, Marstons Mills, Map : 1.03 Parcel : 055 Dear Mr. Fregeau: Upon recent inspection on the above referenced property several violations of the state building code were noted and brought to your attention via a phone conversation between yourself and this office. During this conversation you assured this office that the violations would be corrected. To this date, the violations still exist and you have not contacted this office further. This letter is to inform you that you are hereby given until April 15, 2005 to correct the violations. If the violations still exist; then this office may begin legal proceedings to the fullest extent as allowed by law. Thank you for your attention in this matter. By Order, Jeffrey Lauzon . Local Inspector Q zoning5 ■ GARAGE GIRT BEAM by Weyerhaeuser 3 PCs of 1 3/4" x 11 7/8" 1.9E Microllam@ LVL Tj.DearrQ 6.30 Serial Number:7004103627 User:1 9/4/2008 10:28:27 AM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Pagel Engine Version:6.30.14 CONTROLS FOR THE APPLICATION AND LOADS LISTED Overall Dimension:24' I I' d 12' = 12' ' Product Diagram is Conceptual. LOADS: Analysis is for a Drop Beam Member. Tributary Load Width: 12' Primary Load Group-Residential-Living Areas(psf):40.0 Live at 100%duration, 12.0 Dead SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/UpliftlTotal 1 Pocket in masonry wall 3.50" 1.50" 2565/742/0/3307 L4 None 2 Wood column 3.50" 2.41" 7100/2385/0/9485 L5 None 3 Pocket in masonry wall 3.50" 1.50" 2565/742/0/3307 L4 None -See iLevel@ Specifier's/Builder's Guide for detail(s):L4,L5 DESIGN CONTROLS: Maximum Design Control Result Location Shear(Ibs) 4742 4014 11845 Passed(34%) Lt.end Span 2 under Floor loading Moment(Ft-Lbs) -11224 -11224 26772 Passed(42%) Bearing 2 under Floor loading Live Load Defl(in) 0.119 0.394 Passed(U999+) MID Span 1 under Floor ALTERNATE span loading Total Load Defl(in) 0.143 0.592 Passed(U991) MID Span 1 under Floor ALTERNATE span loading -Deflection Criteria:STAN DARD(LL:U360,TL:U240). -Bracing(Lu):All compression edges(top and bottom)must be braced at 24'o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -The load conditions considered in this design analysis include alternate member pattern loading. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by iLevel@. iLevel@ warrants the sizing of its products by this software will be accomplished in accordance with iLevel@ product design criteria and code accepted design values. The specific product application,input design loads,and stated dimensions have been provided by the software user. This output has not been reviewed by an iLevel@ Associate. -Not all products are readily available. Check with your supplier or iLevel@ technical representative for product availability. -THIS ANALYSIS FOR iLevel@ PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code IBC analyzing the iLevel@ Distribution product listed above. -Note:See iLevel@ Specifier's/Builder's Guide for multiple ply connection. Operator Notes: EXSISTING BEAMS PROJECT INFORMATION: OPERATOR INFORMATION: RON FRAEGEAU Matthew Gustin GgWILMANTICK RD Mid-Cape Home Centers MARSTONS MILLS,MA PO BOX 1418 465 ROUTE 134 SOUTH DENNIS,MA 02660 Phone:5083986071 X4987 Fax :5083984559 mgustin@midcape.net Copyright ® 2007 by iLevel®, Federal Way, WA. Microllam® is a registered trademark of iLevel®. 1 ■ GARAGE GIRT BEAM by Weyerhaeuser 3 PCS of 1 3/4" x 11 7/8" 1.9E Microllam@ LVL TJ�BeanM 6.30 Serial Number:7004103627 User:1 91412008 10:28:28 AM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Page 2 Engine Version:6.30.14 CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Primary Load Group 11, 10.001, ^ 11, 10.00" Max. Vertical Reaction Total (lbs) 3307 9485 3307 Max. Vertical Reaction Live (lbs) 2565 7100 2565 Required Bearing Length in 1.50(W) 2.41(S) 1.50(W) Max. Unbraced Length (in) 288 288 288 Loading on all spans, LDF = 0.90 , 1.0 Dead Shear at Support (lbs) 536 -1009 1009 -536 Max Shear at Support (lbs) 715 -1192 1192 -715 Member Reaction (lbs) 715 2385 715 Support Reaction (lbs) 742 2385 742 Moment (Ft-Lbs) 1587 -2822 1587 Loading on all spans, LDF = 1.00 , 1.0 Dead + 1.0 Floor Shear at Support (lbs) 2131 -4014 4014 -2131 Max Shear at Support (lbs) 2845 -4742 4742 -2845 Member Reaction (lbs) 2845 9485 2845 Support Reaction (lbs) 2952 9485 2952 Moment (Ft-Lbs) 6313 -11224 6313 Live Deflection (in) 0.072 0.072 Total Deflection (in) 0.097 0.097 ALTERNATE span loading on odd # spans, LDF = 1.00 , 1.0 Dead + 1.0 Floor Shear at Support (lbs) 2486 -3659 1364 -181 Max Shear at Support (lbs) 3200 -4387 1547 -360 Member Reaction (lbs) 3200 5935 360 Support Reaction (lbs) 3307 5935 384 Moment (Ft-Lbs) 7987 -7023 403 Live Deflection (in) 0.119 -0.052 Total Deflection (in) 0.143 -0.036 ALTERNATE span loading on even # spans, LDF = 1.00 , 1.0 Dead + 1.0 Floor Shear at Support (lbs) 181 -1364 3659 -2486 Max Shear at Support (lbs) 360 -1547 4387 -3200 Member Reaction (lbs) 360 5935 3200 Support Reaction (lbs) 384 5935 3307 Moment (Ft-Lbs) 403 -7023 7987 Live Deflection (in) -0.052 0.119 Total Deflection (in) -0.036 0.143 PROJECT INFORMATION: OPERATOR INFORMATION: RON FRAEGEAU Matthew Gustin WILMANTICK RD Mid-Cape Home Centers MARSTONS MILLS,MA PO BOX 1418 465 ROUTE 134 SOUTH DENNIS,MA 02660 Phone:5083986071 X4987 Fax :5083984559 mgustin@midcape.net Copyright ® 2007 by iLevel®, Federal Way, WA. Microllam® is a registered trademark of iLevel®. 4 . �. {, t s.. 6' = The Town of Barnstable '"" sS. ' Inspection Department a Mal 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D. DaLuz Building Commissioner _J May 3, 1994 Mr. James A. Aalto 6 Willimantic Drive Marstons Mills, MA 02648 RE: A=103 056 64 Willimantic Drive, Marstons Mills Dear Mr. Aalto: This office is in receipt of a complaint alleging that you are operating a landscape business and storing equipment at the above referenced location. Please be informed that your property is located in a Residence F zoning district the operation of a business and the storage of heavy equipment is in violation of the Town of Barnstable Zoning Ordinance. Contact this office immediately re the above matter. Very truly yours, �Z �c a/ l - � Gloria M. Urenas Zoning Enforcement Officer c� GMU/gr. cc: Town Manager ti LvC _ _"_`"f 4 1.i_..a-L i ii'114 I 1 L.r DRIVE l.J 1 1 03 1 L+v 300 0 Co .'•C' Y 51703 MAILING vl n 1 - i i PCs v - PARENT R h I T h�C ADDRESS ESS. _.. � "n a �-�., f 1f T f` t T i:.. nn1 T nMES I MAP nr-E r C It, TO - H7-IL_1 0, I..{HI II:.J ALLF_.P4 I�,AI'" H1.L.H' �•?H,r �v !� 1 � =)0=)') ' i WI, 1 TMnF}TT Dir-,•. SPa SPi SP•-+ .. MAFiSTJNS MILLS MA 0264= AYI_' 1962 EY•`. 1970 OBS — L.OidS LAND 26600 imp 49000_)(_)`•- OTHER I' ER I __ _ —LEGAL DESCRIPTION---- TRUE MKT 75600 rEn CLASSIFIED # n!1 . n 1 1 - -:+i � - c TMI-. �9r• 50 nS -�'ri TI'L H14L+ Y 26, 600 I•',J�..� ter;i, �._:�'+_�_) I��L"� :; IY' ^r; =)t. _ i-,.��, � #BLDG(S) -'CARD-'1 1 , 9, �)!1f•'. DESCRIPTION 1 TAX YR CURRENT EXEMPT" TAXABLE Tri-L 76 VViLL IMr-114 i .I.l.i DR TAX EXEMPT #R 1843 0125 1-.._G IDE 1T:1 75600 75/.+0.0 75600 i UPEN SPACE COMMERCIAL EXEMPTIONS SALE 00/00 PRICE n-Z 13_5/=_4 n,D LAST" ACTIVITY 'i 01 0/00 PCR Y TOWN OF BARNSTABLE • w7'• '' BUILDING DEPARTMENT COMPLAINT/INQUIRY M PORT Date '7 `/ lJ y Rec'd B �� Assessor's No. 1 `�-� Last Name First Name - ORIGINATOR Street... r Village State Zi . Tel e hone: Home Work Descri tion• rcompT., INT2/ T � INQUIRY O Requestor's Signature COMPLAINT Street Address C� sl�JL ?� � e LOCATION OFFICE USE ONLY INSPECTOR'S Date . r15! Ins ector ACTION/ COMMENTS L FOLLOW-Up ACTION ADDITIONAL INFO. ATTACHED COPY DISTRIBUTION: WHITE - DEPART?LNT FILE YELLOW - INSPECTOR PINK - INSPECTOR (RETURN TO OFFICE MGR.) Kisci LOCATI O ROPERT-Y, LI MAY NOT 13E AC E .STANDARD LEGEND -1 . ° NOTE:not all symbols veil appear on o mop 7 M P 103 ° �-� GOLF COURSE FAIRWAY 4 MM� EDGE OF DECIDUOUS TREES �- EDGE OF BRUSH T_ ORCHARD OR NURSERY .... .."...•..' V-P-V-V EDGE OF CONIFEROUS TREES MARSH AREA / EDGE OF WATER 71 . 0 -- DIRT ROAD DRIVEWAY PARKING LOT PAVED ROAD DRAINAGE DITCH ————— PATH/TRAIL 1 PARCEL LINE** w no <—MAP# 1 03 21---PARCEL NUMBER #tedo—HOUSE NUMBER P 1 3 7 01 / 2 FOOT CONTOUR LINE _t o 7 1 0 is 10 FOOT CONTOUR LINE (L� \ Elevation based on NGVD29 1 --- — �+ ;�4.9 SPOT ELEVATION I oc_�o STONE WALL f -X—X- FENCE FP RETAINING WALL 0 RAIL ROAD TRACK + \ / STONE JETTY F SWIMMING POOL PORCH/DEIX 0 BUILDING/STRUCTURE DOCK/PIER HYDRANT MAP103 a VALVE. o MANHOLE -�• tt -"— o POST PPP FLAG POLE T O W N O F 13 A R N S T A B L E 6 E O G R A P N I C I N F O R M A T 1 O N S Y S T E M S U N I T q SIGN a STORM DRAIN M PRINTED SD1E IN FEET *NOTE;This mop Is on enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES:Planimetria(man-made features)were interpreted from 1995 aerial photographs by The James -"-' -- I 1°=1 MY scale map and may NOT meet of properly boundaries.They are not true location and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD m UTILITY POLL n TOWER Q20 40 National Map Accuacy Standards at this do not represent odual relationships to physical objects ' Corporation. Hanimetri4 roDo0mPh9 ane ve9ofiHon were mapped ro nceat Natianol Map Actuary Srordords ¢ LIGHT POLL O EIECMC BOX ' I INCH=40 FEET* enlarged scale. on the map. of o sale of 1°=100'.Parcel lines were digiNmd from FY2002 Town of Bam able Assessors tax mops. fAdgMconservation.dgn 03/15/02 01:52:21 PM i 1 LIC9., � � y r`1N�k rxA: 2.1 OW BFt L f j+ • � [�trator , L. I I .0 lQ1II L{]flt! OldL--Mjll,Remodel J � ... :1.88 Tiriiber nt- 4 t �t Ar �sfonsviif(s MA y 1 The Commonwealth of Massachusetts Department o Industrial Accidents Xd _ s• 011lerollarasal! -- - r. 600 Washington Street . Boston,Mass. 02111 Workers' COME t tLtatiAII insurance ATIdavii Ztn:ne �n �n Fr�GP�U city ,l�tAls MPUS �A l-I l t ��L �,��tz l_SJ£s� oar Cl I=a hammW=per, all tvaais:aaysei£ ❑ I a sole 't:tor and bave.no one is aav } z . yees wniaa$ m this job.Iamas gin .. .:., n .......!.: :.:. .... ......r...... .:......4............r..... ...!tiQhll?•.�•. "'+.:y!;}�^.- o>,;. :??�;Q?ym�Cw• -•+�{•:eu!:^:-":.'�.?;�"--""'"" ...,..:vrn.....n!..y,......,..:... ..r.,-:rr....n.,. :. .t .......:... ...... ...n.a.-;�+!?SQ�??`.e?'so�.... r!�?<aa., ..,>::....... .:-p. . t�' .:eo.,. .J.,. ':{:�:.y:'�;-T•;x ;:�•."::j'.�.!..;...,.{,;; ::).. .:v.-:}.... ....::T.n..{...!:P.4::rin........ ....r:!-:::.:-:.vt..♦..v..... ..........:...: .. ...-.,.v:n:.t.. x:. ........:•...�^H `:�T...I...:..v ..}.v-{ ?'ti;1•i>i�...n..4:r-:::n.«v. M:Jvv.'J':•.+- ..:.^:,.T;.;x.,•.•w:::;{:.::)n .v. ..:-:nv:.,r.:4 vu x•:v.v. vn. v-:•.•, -:Y::::........:.v{.J`aw.♦vJ nw•:n!-:::'•..,.J.-,v,v):♦,•.:ta:n,,...vi{J:" vN..::v:;..:r�?• \y:::?-v:�a n::T:. , •rr...:....v.;..,:::....}:.•:.tv .},: t...::4.•}}::.:.. .{.. :...x.-.;.:5{:'�-'}:.:..,.•.t;{r. .xv /..:.... .!Ps::.<;......-. ..ve, "v�ti::::::v{a.. .,/.:•.::.., .r:�.::;:;.:.;-::;}:�`T:•}:M".: . ..1\ ,G•: :). v.�:. K-Y.v}r} ,v�::.::uv,!MJ.a .al.. v�- �(-•A'r•• .{4}?a •.:Y:: wti:: :Cj<` !a4:�:! n•.tai-}vtiy.•c;.,••: •. ,r:. ., .... rJ.:• ,•K .t}.. r.•f{?Pa .As:b>;; n�:: •:oY. aK.oi.7F.r'.t.:f.;'Y.'S♦ ::an yr}::::::::....... r.,..x. ;4 2. .- ..!:: .T:;' v:.}. ..�{a>Z..}...{-•• Via. "v< �bw:4:w ...:<.,{,{ .,: �.T:n•♦.: � ''•--y.,x-.v.:.{:;•}:{•:x;. Ee'AID aQ�T1a�N^'{���A��-k�-'� � ...kl,.--•:«..}'n•wr.;:v';.}�P�ya...,ca�>:� �"'iSa ... r..;at:<oaartrb�a.,wcyz::„•".•;#%3::}:}'^?':<��"{`;;:":'-:"' -, •:.:.......... ::::::::::.::::..::n ...:..v::. .. t t v.:,,,.••. .;. ..:::>w.r.;}}:..,.;., .,.. ,. .¢•T\v.< `•,at\:•:.:ta,.. ...r..... ,.t.„n.. .,.,t.....,..:n ..r..r.... ...aa».. .....tD.) ... •::e!doc... .. ...n.n..n ..n.....w ......: ..........r n.:v,.?nvr .AY.? .... w...r\Z22 .... .� /. .. .....,............a...v/:a v r.......n.4A! .r.r!......:w: ...a.vx ..4.... J♦Wa.. aCn. ... ♦ /. W. ...twW «,r... ......,...n.... a}.n.r.. ...:. ....r a:!•. •. ... .♦�'. , , .4n... .\: t.....r .......,...:.......: n r.. ....>':.....N.vO. ,i7 ...... .'•S�F•X:.. .... n.v............. :... .......... .... r.........n ...... : }:......t:.>...,r....................�iC`',�.^'T.`.�... .. •. ., .. ,r ........r....r.r v. r.. .'.•xnw.i...n.�}..:C l•:a'•..• }"r. v--'`a'fJ'P�\;•:fSJ••:av{t.+:a•: -}}:!nv.\:is•>. "'< a •.w!.Cyww.wa},aay.w.'ti ati•,::vvJ;nyvlw),wrYl.!}:�.. ??tf::'f''^a ••.•« v:..,. aa..0;>.. V' .o•':o!co :;I •r.n ,�. _ o.,,.•, .('> .t-:�f:f>:: .:r !..,.. Q:•:• .: i^•:w.•.- Pa "C ;;:: ti{n. r:cx�!!ne.J�r{... ???`-:A4:':::{:<::�:.,,. } .....,\t..:ar{.v v .rtr/ rr,«v ..,w,. ?"r Z. ?R.`^w<wwa�pr..f,Z.r,,.naY 4;«,�:.,•.na..!.n}•n�f�?x•..a.;......;...;{: :Arn,;+}:{4~.•.,..;r:-:•.•.•,�x..y.-.}}<;-:;P. 4f• .:.oa}:{:waJ�4i"�.::P'. QYrj,.^�'♦'P.,.l,,r.« •.,t:..n•t•:::n•:{:•-::-::...;r..:.:.w:...... nJ.:...a••a.. w:.., .....:.°.\'ice`,♦>,.!.;:: .,.. .v-./r !�+. wv,.,•x�v.. v P^. .Y•Y C•?iw\v'P\h--:v::?~:iii�:L�}. •.}:•..,TT:{{:•.,.':«`:-n., : ... :•..T ,- ... ...,N.{:},.L ..{•T:oT:.•^.;:x, �^a:4.r: �w:a '�.} `^.•i%a\i•.u♦«$^-.,,•�• -� an .. ................r.:-:. ...:::r:r:.,:•�::::.-::•:n....::. ...•n.:.•:..:.'.. .. .�..... -.: ...;:.... -.,.. .:.. .4.... ...,�...;..:i:?;.�.C:.C�},C•Sdrwiaricov."y:f'„\a.«'.c'•'+{:?�:::{:::`+•�::::. . ...........r.,.......♦,,.,..;�....:{...v.., «.«.,,T{^..,....�.;wapvaax3G>,,�:!Y�"'yK,y!'DT: ,•-°�?}�,'.'-.c.�•:aXi-w-.;?.:{-xon.:•`:ax.,?n<a,•--.:..,,{,...x.,.. ., :{•:•::::::::••. rr.:}.•: '•.,;;.d/K:r.,.3•.vc;.,t.�....«v}x :{r:rP)•??:::{�?\,-�- :..;;:..l..t,;.,.:.r.; ......ak{{aJ?:Z?•x•..r.J},K� T.r?;.`�:}•:::•.♦..�:,.� ..Jr>„�yL;•r,.:}.:•::::.J .L....;:... .::. .,..... 4«.r.«:.nr. n.:•.. ';:•+:?)`•�u4XY���.�. ?- .-\.. ._i.... :{n.. b{...La•. �-rx"� :..:A.v..n.nv:?{{P:P`T..a•.:...v::: ... ,. .k�•%..;}:• - •. .; `^, ..,, :• ..•t!-.�( ,\!E000�!lY'VW�.�..•'I? ,;f • r,.{ ...r:::::.v:.v:........:•:•nw. a;.va v : : :::-.. .: ::,5 ::: t..Nnti.ry•-., >,},: ,n;.:.\r. a:•,: .x;}:ax•'.;+.� !.}:v:..a;:::...,;waa•;.{t04,.R5,'�s.-a.«t;=?r:^rR°::�. r,••: �.fe. ❑ I am a sole patient;gsleral coatracwr;or hometrwntr(dr+cie° and havts hired the listed below who the f �Qa ollowing ..poiitxs:. ..... v::-•:::.,•:..•-•n,•.w.•..w.�.......n:,}:avr.{c{•x,cc::•:::.w•:}.!..a..r.,:...,_..... w � :?`, va♦,vv N.n.v,v........ .. ..... ... ...... ,. :.v-._..:4:a'a.::..:w::--.av:v.,••:a:;�-:•.•x•}x•{:}- ...... , v:na««wr^vn.:•.......YM..na... .........v.v........ ....... ...... .:.::: :.n\n.G.... .....wM:!�"vY'%;?:'�•:a ....v.::::::.:. �n a ... -...a...a:nv,... -..1..:.:..••\*q r,..n SJ:;:.Cy :??` i�:t}S:v�ifT:is r..!.......:::-v............•v:n•::v•........:..n... ....w�w:--...,...,.r.v....:.P. .... 3•�-.•v♦rw:.:. ...vv..a. >' Y, o .,.......,.. n............. ..n....,.........n,. .... .. ..... .n.nw::{•.,-}v.}}':':.. ......n:o};!v:xnGvw+.}:. .. P. .v:< •.:v:>:S:?-:4-«vw.v}:n..::.}:,.,.,..:4x^`::v:TTT:;;v::.T:.:Ti;-:.:•. «avi w:•env-„v: v..-r{,.r.:.v1.:•.v^:•.•n••.v:•.,v:.!wnl.^::\•rna ♦ ..>:Y}.: P+:T'.;..1��!'!;>:C:S..,N.:.a,«•r:::rxv:m:•:ax•})Y:-i{.}`TxaTTh:<\�.+,y:}:;.}}T;{.;{+{?4xx .........:\:i.L i�P}r:v,. {,., � • ....r.. ........ .....r. .v.n..... ........{v..\..n;-.i:..n.},,.:.:nv:v.v:.....-.. .w-.:{a'{:•:,ti!.:;.. x'tia.:,.:.:,1`jC:':r. \♦K {P♦• ,♦ .T:C•:'{•i>w:1.}C?:J\iy)::v v':JT}ii:-:}::::}i;: nv^v:n...,,.},.T.{..T.vx...•:v::YT vnw.{w:.........nwn... :....:..n.v....n..\.:{,. .....v♦v.:w:.a,wnaa..«M♦.:a...:vav••, `<'�, J.11�\.1♦� . ............:.•..:v.,nC....-.•................v................v....v.w:{:v:r:•:n••+:n.rn, v-vt:..,{ • .......... ... ., .. ................ .. ..n4x�:�vvJ:•w:.vv:•:nw:v::•.mx,v.r{.},: a . ... .v;.�'-,f•x:{;'':`O.-C� j V:•:<iy{". !:•:•:.t•:•':. .rw.vf.V.,uw.,•.}yr.�:`rh.wn.{,.y_ {.{{:r:.x.C;:•x;,.y,..va;,}:n�.:-,::.a.... 2•,.y-: •,.w.a.W a. .,a :...a.,..-.;. r......}.?.�\ .: ...........-..c<aacC,-f.:..::> ,.. ..a..`....h.{<,...,:t•,-n<•):>r..,:.r' R{.x:l•q�'\n .....i.. 4,*1 .. ;ix�:t.�}��fwi(?��♦�vX-R<�a:i;.•-:o:::.:.•.,-:,;::: .r..:.... ,,,,..,,.va..-arr�t:.:x •:n., ...n -...�\.. .rP.w)7.aa;.n:-:.v.•::rr>rxf::*1.{x;•„59{{ng:.?3:;?.ay:,w... •::!::•.:wfXc,co.•awen>;AwAo},xF":.�... �t,• `�!LD? •`',•."?`.:•.':• 'k-\•.. . .�. .,. .M..�. :;�ati:.�?'�:aW::.ay r.r.:$•r.::•:.:�.}•�; . ,...w:n�.,v.v. vrn.Pf)^ V. :.v.t......v. ..•.v:. .,.r:!M..S �P.;::..n.4J =\`a«a �:J'l.C^�:T:+.{Ca:T •?i- .^•2vv.. («� � n 9.'S,�`:2:--v:'�i.Jii.•n'['',� v?Z X•r.9....q.� a-.a\v,nv00vR..k �y� C.}:ir Y}:.�..M•?`T .a..:n,-w.....�•xv}:A,w..n .. ..:,.._v.�.vr<.�:f\ ,..... .Y).�rnwn .. ..w:•:.{x?]q.YMfr':JW ''•)??•' w,?`;•.'':^•M1'•. C:4C!"!i.:;y�:� .♦�.o.L,•""....a,aP„'X:>?:�;':i:iw•5.,,`C'}',•>Y"t,•,,.,...,., <p>.. ^�:��� »i.�,�z..�.:�x r < � �.-� ;g - \D�0?a.{o�9J:<d,.:,.•:x•.:.:..... , �A�Ate:�Y.1?u?9.'t�? :'CIY�F!'.,Ss.+.??a.Cw:lixV��w9�Y ..x •.:,a.,.- ''�:z�ta��•^cl�-n"-- �.nary=,-����:,•v}�"�J,{�»�}. • •.:.<S.;a<�?;.;?..•{:•',ti'c:;raww}.<�'•'0�'�'.. EMIR : <d:. .:6G l:<?.4.:•:.•.. at�t ...::;•xy,?..,x. ?.:::?C?Ht•3v4�::;3�,'Q?'``L\!'fNif?•.,•a`. ... R M11T,[ �...:�.::.:�A?^•::•-..+:>i:���:i • .{.•ix!;/•r\}:. <"�: a'4 �T..>a �$!%s;ek•`'�a^„Yy<'�,�,t;;.,Sv'"FY;a �i • .x::::r••4<•.:...}.\Y.�v..+f•YJ>)AG... .:..rv. •.v:rxr:w.Va•. _ ...... C;. ...00x:mr. :...« .r•4{'tx f3X.}Y,"�"eCCM`": �X!:Yc'� : --Z,. g :2%^% r.Y:;.,p?�•<;:ww•T....Z�';?..}.a;•t7i.•:^7.`.� q�°�`5. ..ate.:<•'.q ?+3�4L..., ... «a.ox•,:1:.::•''::::.. > ,{;Y6r::•.tt:. a<b;3:y,z ..... a�S°a� �3. n«� «v ........ L .... .........,..;...,.: ,v.••.,.y:.,..,-.`--,..--.r••;„ ..:..-:•:•--•.,x:::-;•.}xx �--n•: �nLv+�; %�35�<'�F%i?::' �":::::' . :e: ,-'.ti.^..-.;:'.�?'� .r)q•}x;{.!.:r)-:�"t r<n:;?�:�T:..}>va,:.. ...,.5..r.•.?.�.rrr.,-?a.. :NJ.x :v?w,v.: a"f , •.::{4}.. ..... �:`.:':`:+'::x"'`-::r.'::`•T:�>':,+� ...4:.C.....; .5:??rvr.-r.::4:•xr r:x\\`:'?�•�Tiirhx-<.•.....y<.: ...,3,:Y-:n?:::..'rW....14•,*u�-•, a :• : _ VKx '�a•. ♦: �aa ��rZ'-'`�.t +�,,, ••}o`.JK:„�3 y+.w\•}T{abw,{3Y)Ka}>`'t)?S^.:}:{-Jr.»x{L�}T :x:r:•.{..;aarFL;o:`<,.};{.:.Yy?«♦a:;:�Y:::�'•iS::};•.- •..-:.. :- a•)'�•.. ii.���ic:?l�:*:M.�?3�e�^iciiri:'Li�::::: ••9�.�.....p rn .l�a��".nr♦)`.i1."tpo•`�!'Cs�o`�¢i�r.:G`.y%�de:aaeioaoou+?.�:�AfY.??r �-'ax♦>YaR?�Sw�1 \� a•{P;xw. «r.♦...+Garr: a>a:?vo:•.f4)J?•>•-,?.. '::�.. .... ..,..,:-•„• fir... .--- ..}. :} a :vc:ax,. ,Aare :.r. a...{,•.:;:.:ao..v.:.«,L4•.Jak�taDJ..{;xb>x,-}xo>f.. ......:`5.\.::•.}. .-..?^�Ji :::^>{'•a •-.•,x;• T�\.�Y:n'4,uTJ:u .::;�i:;t:�i:?5:::; ?:.<;.,.p..n.2:::•..>:.�-::•:• :::•v+r:}}a.;...::.:;r::.TYx->n•).a-n..:va•::..r•:.,-: {.:!ki::::::•r,.,:,.,:•:.::a�:r.,.....�::�...4..:.•:•.:.,..`rx x2i:ari.. ,.,ax•:ea:.'' .ni.':.>:;i<::...:�,Jave*n::'�°:a.. vr.{:•::}}L.}}x•}:-.vn+s:,^!'�,�-T!:{^'^^, v:• r ay{:t;\;..?:.r..T:c•:a':%n::�.;xT:.t;.-•S,.N.,....,.;..,....:♦-,c{v:y.!t.>..,:.w�.e«ww ,,+.w2v.•- .,,�°a`,dL;�w♦�'qu•y�.'�n.>^�,,..�.::�a.K�av}?::�}Y'X4f:+.?y:i}::,}.ex{.:. .:•:: . :. ...,-:J.;...:T.:n::^4•c{,�'^�}:"-::-::�•,:.:..,,:• �ri•::,,t.,.r..... w.«�{-\;�-:??°' wwY�a'. ' .,x?tr :addrrsr.•>..• .:....... ...:..... ,,..... .' .,:.....,.: .��w-::;•{>?'c:?%-5rr.;:a;;:::;T�} L•�:�:5::• ' -::.:,•: •:-:..r:n•.:t,.:}}}r{••:::.. ,•:::..,••:..•n,.a..:.. .n. � w�i.., »ictr�;.`"%;!C}-•.�b. .�->-.T:-.;.T::a.<55.-.a::.:,: :.....:...............,-::T. •::-.,:.:,n-{:{ ..yn}:::a:%•:•aw) .....^} .n.i... ...o,.....ras..r.n n....:,-.v .......:C•..t:..7.0�`! ..3°•'.•. .. .!�Y�ri��•� -.�'♦. �Ct• 4r:... ..:v:::.f. .N..{ ..::.•.::•.r..`+... :. .. ... ...\:n\v -A:P.•SYr. ::..\...::v-rnq..v:r\:y.. v.. ..v ..✓ :v-v..\:::-: ,.M'\r..>\R•::>P}T....r.:T.4iJ:•::n:->a}y!nxvTnav}•;i+'f:: "::::: a:\.:.v.tw:YYJ x-:Y - ------- .r. .«}..tJ. v+.it «;�{n-.!•.,.r.n\'v4.,,..,-)..::.n..., ...:vv::....vr.T:N..,}x{:•T-..vrF..rrn.`x{,+:vP v:rx•. •v. ...Ht}: .�.•wrN. CS4.Zvw�^'i >:r �;\a. :.a:v::.Y;•:v:..... .. ... .....1\....... •,«v 4::.«.... -::v:-:•. .v...;.x.:i�• Y` •G'� :4}. .vh^: `,{.v n...♦ .,....n..• v ... ... ...............e..... ....v.n v:/, .,vvvv w, .......•.a...:rxr �,v:w•: .... nJ,v,-wJ- wkrn..n..v..n•...nn. ....r...,,.vF..}r.. ... ...... ...r........... ....:: .nn.'?.?..v > r n•xi:••::.,.v. .... a... - `Q Y .,. �?p\a^h` `.:od.. ,.!�• n.{{. h• ><•."`l�'. .:}nor .,X. ....I?{:r}-.,'v 4x:\:vww•.v.H. :nL.}:..... -..x. .. h:4:::-;.,.}.:::..:r,'?•\•x.4..r..! 4 •..J�'• -.-f�: ..:..,...::r ..5 r.... ..< .. ...1 ......,.: : ...f. .":'k. ....:.. x..>o n,r:'k"�.. •:. �Y"J?'Ayxk:e±.�'by:P.P�h.'r•}"`:�vn�£!.a•'r:r::a}xT -- ' `{;C.xv'T}h rh-TK•.P.r,{}. YA^.�i'+!.!^%v:.yWn:}4..vr.,.\r!,a::n•.-:5.r!...n ax,wv..P:nvh�5"iFA...w.4 yam) W�t4Y<ay.a4M1N4 \y}a •.�`! :i x•}"i \ ....�:•:.,:.:�. :tt,•:.,•:n,..«•:rna. ra{!♦,::{r,.!•.. .....:.....o...S:?.... M�`•' ..S.;a}av .,-.x-:<..:•n-:::::.x:.:;<:a::i:�:%tM1:i .♦....n:T:v.... ... ...::.!'t::r.:.. ..... -,..n..:+:•.a.n-\•n-:r...,.R......n3:r...,........ ...� ..x•:.:•.:;:.}:;:n.,P u!r.::•::•n•.....a.. >.•J.W`YJ.v .k .. .ao}...r.ro} :} -. ..{..<. ...<... .... .. .......r .. .• .x,,, :<$�6.'a awb�{}.,.M.ax;taJ:•}:.{.Tn„},..,.. ..?.. n.'?.}..... r-.-i. J.6::!!Vii.PCv :v.P..v.Jn<v,•,va::r!{t•}!a:wY.V Z •>. ' aa.tv.G.., .a ♦�.,L{ ::►al>Nw%!:Y.w:�!:}:?::�vyri,«J Ti• n.r..w '^ .....4x!±UY'ri;v. a.nn... ..v. �. .� '•]�.•}; V,:`:'+:w.w.-.«a:P.... •..?..4:y?:,Tw.,oRa;•{;?-. ..�5:•\{:w`Y.::.-�?aK .v\,.+.« '♦C'Tw>�vf^:iS� Y�Q�'., >}}?ri::• .Y•4::j;.. .... .<,.,., v" .. ..'<{riJ;{.;.�-`p�/wv .>."yJ:'K\:<+J .. ..K UCI�? JA / a.;?v<v"'ww-'<►11•A??♦navy{,??{�i{}�{{:.. •ea.R..o y^.:*:�:b>r..r.r{'..!.T^M!` Y^�{';�!'?�...., ... v•..:��a�� :,;. ♦.5..`..:.:....::rr{{la ..�...x-.naoe�o..r+�+..oXeea + `eta' v iy �Dw �..... ..<{'.-. !...::•:{:{;.`�,.,,j,�., .5.:,...,`�;:,.,,tl,.al...�.}::.•: .:!:... x!e"?Tea-nw.. :Dc:-..+.,««•.:,-.r.:•.... • C'C.'CQ:::`.:i::•:::.....::�::::K;!. ......Ra}:;:._:::r:..):.:.:??40`. �3-.r..;�.�°tp••o°�..`:°.....n ,:...::r•.... Fxgm'e to secum eorersr n emda Beetloa 2SA otMQ.L4 e:least fa tine fm�ost!!aa d estas5sei peealtin d a chic oP to S1.SOt1.D0 smd/ar o�7een'huprbommosmst as wed as duff pmaLdn is tha form of a scup wo 0==d a am atsim t)tl a day against m& rumdavismA OL"a oM of this statema d mq be forward"to the OIDoe of Tstt wdgzdcros of am m ar.00lmato tesdodm I do hocby y rkr P P� °fPQl� 'ate P�'�abos+e u t}zve mid ea�ra:: pate 1 ,'- r}Dftutze 0 ofIIc4a1 me only do not writs is this area to be completed b7 city or wo o@dal dty.or town: POZESI le:ma M ❑$oiidla�AeF n� Board ❑chgvkifhns .dde response is repaired ❑selseonea's OM= ❑Health Departme1st eontactpenon• 'pbmaN; — ❑Other (terra 9/9S P1/1•) • sib of 0 • ,, • .• . eggs • • \ \•• . e • • • •9clow. .• • • • •" v. • �nr.1• • . •• i1.. •• • • .. •• . • / • w••1• • 1•w•I • •mow••�• .• • .•. w1•N • .•• • • • • • • • . 1 • Ewe /. • - • • I I 1 : lose 1/•11••• • y • •• • • 1♦ •• 1.✓. . •• l•.• . w.l•w •.1•. ... r.l.l• I.. •• •�. • •• e •Y • •..• • •IHI• . • .• N •. •Y w•H• rH wH► •1 ••• ... ..•.w .. .mow. • •1 /• ••. w r•IUN..• .0 H• i•• • 1 •11/1• I • ••w ..0� p ••► ••.• ..•• 1•• ••• •INN.•. •.•.••+ .*so— ..•• •.•I• •INR •.• •11_ 1•• .•. •...�.• •/ 11 U .•• eggs 1. �• • • •.•w.• O 1•U • «.wN♦ .1 rH•I•IH.r..••4 •/ H U ...r Y. •d _ sees • • • �.•• �• • ••Y. 1• •1•.!w Y.I.•I•w. .•. •1. •• 1 1 •' I � • ;11 • I 1• •. wH •. i• • • .•.\ •Y.0 Ole .• Y•NIY. w •.. • H•• • • •• ✓.•• i•.. 1 •r • — • gees•�\ ' • ••.sees • H • U• � • •�. • .•._w••w•I\ I •�••• ••% oil a • V!/�j1%/!/,��/.(////� • , • •.•••.•1 •• •••1. I• it •1.•.• •.• 1 1 11 11 1 1 0 1 • 1 1 • 1 • • . i I • 1 1 • oil RESIDENTIAL: SHEDS - POOLS-DECKS-OPEN PORCHES- GAZEBOS DETACHED GARAGES FEE VALUE WORKSHEET ACCESSORY STRUCTURES >120 s .ft.(Sheds,detached garages,gazebos,etc.) >120 sf-500 sf $35.00 $ >500 sf-750 sf 50.00 $__ CJ Q >750 sf- 1000 sf 75.00 $ >1000 sf- 1500 sf 100.00 $ >1500 sf—USE NEW BUILDING PERMIT APPLICATION DECKS x$30.00= $ (Number) PORCHES x$30.00= $ (Number) IN GROUND SWIMMING POOL $60.00 $ ABOVE GROUND SWIMMING POOL $25.00 $ RELOCATION/MOVING $150.00 $ (Plus above fee if applicable) PERMIT FEE $ 5,0.OD Q:fornu:dkcost eff:082301