Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0004 WIANNO AVENUE (2)
UGCo cam , 4 A o c ., o SINE Sign TOWN OF BARNSTABLE Permit * BARNSTABLE, * , MASS. 039. A� Permit Number. Application Ref: 201401486 20070964 Issue Date: 03/13/14 Applicant: HANSEN, WARREN E &BARBARA A TRS Proposed Use: GENERAL OFFICE BUILDING Permit Type: SIGN PERMIT Permit Fee $ 75.00 i Location 4 WIANNO AVENUE Map Parcel 117090 Town OSTERVILLE Zoning District BA Contractor PROPERTY OWNER Remarks NEW 12 SQ AWNING SIGN&20 SQ WALL PETER HANSEN DESIGN BLACK WITH GOLD LETTERS Owner: HANSEN, WARREN E & BARBARA A TRS Address: 147 SCUDDER RD OSTERVILLE, MA 02655 Issued By: PCB POST..T1iIS..0 . _ S.O... .HA.. ..YS........ S. _ ... . .O .. ... .._ _._._. �THE r Town of Barnstable Regulatory Services MASS. Richard V.Scali,Interim Director �Fo;9. ► Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us C�b V Office: 508-862-4038 Fax: 508-790-6230 Permit# Building Official approving Application for Sign Permit D L Applicant I ��=� ��1 sr Assessors No. 19 0 50 Doing Business As: I MR- �T�aj-� Do I GN Telephone No. � ��Z� 6Z00 Sign Location Street/Road: 805 MA,1 0 S 1 OS-I r-_IK� I(k,`F., Zoning District:_ Old Kings Highway? Ye(: o Hyannis Historic District? Y(s/N Property Owner Name: U/\Mi'1-, AID SE�--) Telephone: Address: SCJDbZ-(L (>C).4�0 Village: ()S!L ,-V1 .r Sign Contractor j Name: S1Gf3 L,)0QV1S pcC� CALiu ) Telephone: S61 0 -VI0 Mailing Address: .3N OtO 'F6,1M"1A n O, (UMT 1 D) n M I( _s dvy of Description Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified? Yes No (Note:Ifyes, a wiringpermitis required) Width of building face ) ft.x 10= x.10 Check one Reface existing sign or New v Total Sq. Ft. of proposed sign (s) Z5 (�T Ifyou have additional signs please attach a sheet listing each one with dimensions TO TIA6 3l If refacing an existing sign please provide a picture of the existing sign with dimensions. I hereby certify that I.am the owner or that I have the authority of the owner to make this application, that the information is correct and that the use and construction shall conform to the provisions of §240-59 through §240-89 of the Town of Barns a Zoning Ordinance. Signature of Owner/Authorized Agent Date /' j SIGNS/SIGNREQU revised 110413 Town of Barnstable } Regulatory Services • snxivsrnsie. • MASS Richard V. Scali,Interim Director i639• ' �,,or► Building Division Thomas Perry,Building Commissioner . 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 SIGN PERMIT REQUIREMENTS 1. A photograph showing the existing facade, on which has been indicated the proposed sign location. The photograph is to include a portion of adjoining stores or building. For a proposed building or new facade, an architect's elevation may be submitted in lieu of a photograph. 2. A scale drawing of the proposed sign. A scale drawing indicating: 1) The type of proposed sign(wall, hanging, free standing) 2) Dimensions of the proposed sign and any designs, logos, or lettering 3) A cross-section with dimensions showing edge detail. Minimum scale 1"= 1'. Minimum sheet size, 8.5 x 11". 3. A.scale drawing.of the bracket. A colored scale graphic indicating dimensions, showing colors, materials and method of affixing it to the sign and to the building. Minimum scale 1"= 1'. Minimum sheet size, 8.5 x 11". 4. A completed Town of Barnstable Sign Application, including scaled diagram showing location of sign on building or location of free-standing sign. Show dimensions. 5. The width of the building face or the leased area. NOTE: the map/parcel number is required on the application. t SIGNS/SIGNREQU revised 110413 C73>1D m 1 ---10 SN07-4 DDT 2�3 m I HD LOCO M -<{-o I 3H DOHS �o TM3r Z 3 I mm Z rZ ter. mm" MDH H I ..•• Z=O zzD mvz 1 _ c~i�1D-Iz-�n -I t i Z73H "M EA I (-TIOL) Z0M D f mmo m� � mcnOD -< E TI—iz Om D I 3D-imm 3 =z o H i ��_ moc>rn z o t c 1 OmM� � m i rn�M:m :�o E m I O mr m O :z:m m H t cLTIT1= r _0� —Im U) NC) �!—! r! 1 7z LTiLn (J1 1 000 O I I 000 O I I I I I 1 I I I I I _-. x �Zi 1 ► `.. _ AK t. 7t • 1 Z1, — ! A Pete r Hansen Design 4 , VINTAGE LANDSCAPES !} j eter Hansen Desi M IT � t s1:.: �: �_ f___.:: w T 1 ' Peter Hansen Design 809 Main St. Osterville, Ma. 02655 3-05-2014 Town of Barnstable Building Department 200 Main St. Hyannis, Ma. 02601 Re: Proposed Signage I am proposing to add a'sign and awning to the property located at 809 Main St. in Osterville. The awning would be 4' high by 8' wide to go over the entrance doors. It would be black fabric with gold lettering for `Peter Hansen Design' - the letters being 5"tall. The sign we propose would be 2' tall by 10' wide and would be black with gold lettering as shown on the plan. It would be wood.- like in appearance but would consist of a plastic composite that would be both light and extremely durable. The awing and sign would be attached to a cement block building with specified bolts designed for this application(installed by the company making these products). Total square footage of the building side is 600 (see diagram). The awning plus the composite sign is a total of 52 sq. ft. (this counts the whole awning).' Please see enclosed plans and photos. Thank you for your consideration. Sincerely, eter Hansen r i p NA I I o U y i p� ® HC Ift ! i I ' J I , ! i i i 1 03� F-�-_� �. _-... f-§666..JJJ���-�.J�-J� � ` I .i i I ' , I i I r -- ,� sr� ¢p � rYtt I VINTAGE_ L"AND,SGAPE.S; z ; Peter Hansen Desi` `. sp 4 SGY � �... R t•7 } i ! Wwily � f KI NLIN CROVER :It;;', PM U J .Y ►tir �f •+ , , S vZ��.Y.a t R r r'+:�,� .I'R ? ''• t� f<rfA. ��� i,'lA•o lai �r>�d s4t yT `'` w 4 f} s �• lr,p '' � y,.il.{y3 rtL.� �f rw � -h..rr R fit t�+� f� � �f !� !� � i�t•JOi'`rl,1 J. j ! k4Pi� ;"�ti S„ ,♦�� •A�• w .r -�f. <:it3S' y e i at/, t �. . ��i. _; �` ♦T••�Y ` f�'i ',`'ia},�'/'T• ST�` a /t.}i i�:I 4 tr�Y. !!�$: K�r:V°y��y .t�' _, re.,..'.. t'. .a'-._ .K X �.:�,.':'.. W. !lti.i� .t�t'�: �n'Cli:'ii.+ ,!.'�. w �i'..1.. •`�• i KJNIL R r i x }� . 1 _ 1 1 ifrv'�'y • � 1 1I � Ar r.%Sf{ z TOWN OF BARNSTABLE BAR_W li 032 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip Business Name to 1tt It tit p W L R /',. NA r- am/pm on 0 20rQ Business Address A w iAyim AVE %� Signature .of Enforcing Officer Village/State/Zip Q < IV R J ! L L F 1x4 A r Location of Offense P1 i f{ffe'f 1-0 r;7 f LN �... j Enforcing Dept/Division Offense 4-4 0 » Al 1 , o Facts A i� P E t4 f I t- � This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR_W` 403 Ordinance or . Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip Business Name V !t! A it s4Ar am/pm, on 20_ Business Address A 6, Signature .of Enforcing Officer Village/State/Zip lG.0 #A is '2 L C"(' Location of Offense (r? 4� ec)ACd pt.-s 9- !/ t Enforcing Dept/Division Offense 'I Iq r Facts n #r ro-,s <r C `ems- N 11 'Mtoo 4 A JE N This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years): A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) YOU must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. 6. ., DATE: Fill in please: APPLIC'ANT'S YOUR NAME/S:_ E/fta.be f-& Ae CA4L7-74y 1MAA)A6&_n_ `'l �d�• s•ppyy; BUSINESS YOUR HOME ADDRESS: /0 S1-cn k,�-d.�c (�r an�ysr�ge�r Af 62630 5cp r 367, XZX3 TELEPHONE # Home Telephone Number 115-D G 31 / a NAME OF CORPORATION: Kinl in Grover Realty Group LLC NAME OF NEW BUSINESS Kinlin Grover ,ES TYPE OF BUSINESS Real Estate IS THIS A HOME OCCUPATION? YES NO X. ADDRESS OF BUSINESS C=�!:4--wia-nno-Avenue_.Os_tervill-e-,—MAC MAP/PARCEL NUMBER - 040 [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO SSIO ER'S OFFICE This individ al h s n 4Rf e o any ermit requirements that pertain to this type of business. Aut rized Sign re** COMMENTS: �r , Qf�iy,� crYt�(�,_� n Q 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ri Parcel Qvl'® Ut,",NOFCAA.NSrA8LE Application# Health Division MOO JAN 16 Aft 11: 36 Conservation Division Permit# Tax Collector ""' ;- Date Issued � a 0 2 f}tbl�tQt� —'"--- �r (� Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address t al n Village Warren +�,rV I Owner Wariren llAnS2r) Address 1H7 _ 'wdJerAJ(2 ©5�eNMe Telephone � Permit Request W 4) re,`- Y 1 f J b c rood Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 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:O existing O new size Barn:❑existing ❑new size Attached garage:O existing ❑new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial)Yes ❑No If yes, site plan review# _ —Current Use __ Proposed Use S� BUILDER INFORMATION Narne PtwL C me ft Telephone Number Address ( a3 n Q k n S) License# U 2 co 3 �S P m(-)t 02— 0�� Home Improvement Contractor# I C) 1 Worker's Compensation# U 6 ()O9 5 rJ (.P LI A —0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ( 4 ` SIGNAT DATE '6 FOR OFFICIAL USE ONLY i► e PERMIT NO. - DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE S OWNER r ..DATE OF INSPECTION: R FOUNDATION, f FRAME a INSULATION s •FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH - FINAL GAS: ROUGH FINAL k 'gg FINAL BUILDING 1 DATE CLOSED OUT r ASSOCIATION PLAN NO. L . + u Proposal R O O F I N G 1031 Main Street Osterville, MA 02655 www.cazeault.com 22 Giddiah Hill Road Orleans, MA 02653 Mr. Warren Hansen 147 Scudder Rd DATE ESTIMATE No. Osterville MA 02655 12/26/2007 4070 Phone# Estimated by: 42&8767 Mike Description of work to be perfromed Total i Re: 4 Wianno Ave., Osterville Kinlin Remove existing flat roofing system. (selected areas) Install 1/2"polyiso insulation. Install .060 Carlisle sure-seal or RPI rubber membrane, fully adhered. Flash all curbs, pipes, posts and other penetrations in accordance with manufactures specifications. Install .032 aluminum flashing on perimeter edges. All roofing related rubbish to be removed from premise. Workmanship to be guaranteed for five years. COST-Remove Rubber on section of roof facing toward Post Office, approx. 84 x26 and installing new insulation and new membrane roof. C5 , s9E w8al S 1: 1, 11 ■■■■■■■■■■■■�■n■■■■■m■■■■■■■■■n■■■■■■■ ■■■n ■■■■■■n■■■�n■■■gym■■■■■■■n�■■■■■�■■■■■■■■■■ ■■■■■■■■■■■■■■■n■■■■■■■m■■■■■■■■■■■m■■■■■■ n■■■■ ■■■■■ ■■■■■■■■■■n�■■■■■■■■ � ME MEN ■■■■■■■m■■■■■■■■■■■■■�■■■■■■rn■� ■■■■��MENEM ■■■■n■■■■■■■n■■■�■■■■■ ■■■■■■■■■■i■■■�� ME No ■■■■■� n■■�n�■•+■n�■■M■■■■■■ n■ ■■n EM nn■■ ■■■■■■■■��■■■■■■ ■■m■u■■■■■■■■■■ ■■now, ■n■�m■v �■m■n■■s■■■■■ n■■■u■■■no■■■■ --- �■m■■■■■n� ■■■n■■■ ■■■■■■n■■■ ■■■■■■■�■■■ ■■�■■■■nn:■■■■ n■ ■■■■■■ ■■■■■n■■■nn■■■■■■n■■■■■■■■■�■■■ mn■. ■n■n��■m�nn■■■■■■■■mnm■■� ■■■R ■■■; ■m■■■■■■■mm■■■nmu■■m■■nn ■■n■�■■■mMnn■ ■■■■ M=ElE ■■■■■■ ■■■�■■■■■o■■■■u■■■ ■■ 1SQUARES/FLAT 3 , J d .Board of Building Regulati ns and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Reqistration: 103714 Type: Private Corporation Expiration: 7/9/2008 PAUL J. CAZEAULT & SONS, INC. -._...... Paul Cazeault .------ 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card. Nlark reason for change. Address Renewal I' Employment Lust Card DPS-CAI Co 5OM-05/06-PP�CO490//�J .✓/LC -V/OI�LIICOOLI.l1%CLI.C/L O�✓ CGC/tUdC�6 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ;103714 Board of Building Regulations and Standards Expiration: 7/9/2008 One Zn, n Place Rm 1301 :� Type: •Private Corporation 2108 PAUL J.CAZEAULT•'8'.SONS,;INC. s, -Paul Cazeault C 1031 MAIN ST OSTERVILLE, MA 02651 ' Deputy Administrator Not vali witho ignature Boar o ui�mgqgulalfl!! ons a One Ashburton Place - Room 1301 Boston, Massachusetts 02108 f Construction Supervisor License -.::_ :;R License CS: 26325 Restriction: 00 Birthdate: 10/20/1959 Ex!' � ___ ,w, �,b i-• piration: 10/20/2009 Tr# 6311 - PAUL J CAZEAULT ►.::( .. :;+yr_ .i . : : 5::i 1031 MAIN ST --- OSTERVILLE, MA 02655 Update Address and return card.Mark reason for change. (� Address Renewal .Lost Card 0PS-CA1 as SOM-07/07-PC8490 '------------- -. ... -... ' r.".�"^} e'�, ✓lie °�anmxan..aea�/ o�✓t'/�ae�ac/u�aella .{Board of Building Regulations and Standards . ` Construction Supervisor License ilk:• ,- License: CS 26325 _ wy Frt Ezpiratloo t0%20/2009 Tr# 6311 'Restriction:_001_i PAUL J CAZEAULT; .;t ` "• i 1031 MAIN ST \`'` V�--4- !�iS OSTERVILLE,MA 02655-C J'' Commissioner - _ A4Board of Building Regulati ns and Standarcls _ One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation Expiration: .7/9/2008 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault - 1031 MAIN ST -'-'- OSTERVILLE, MA 02658 Update Address and return cart. Marls resisuu fur change. PS-CAt Co 5OM•05/06•PC0490 L...I Address .[.I Renewal 1 i l;mpioynuut Lust Card ' 9Z. 4"towvioa z, o�� � Board or Building Regulations and Standards License or regi ration valid for individul use only lug HOME IMPROVEMENT CONTRACTOR before the expiry ion date. If found return to: I Registration: 103714 Board of Building Regulations and Standai•tls Expiration: 7/9/2008 One Ashburton Pla a Rm.1301 Type: Private Corporation Boston, Ma.02108 PAUL J.CAZEAULT'8•SONS,;INC. .; Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 Deputy Administrator Not valid without 'gnature J67/W -� Boar o ui ing a at'ons an t ards One Ashburto , lace - Room 130 Boston assachusetts 02108 Const ction Supervisor License Licens CS: 26325 Restriction 00 Birthdate: 10/20/1959 Expiration: 10/20/2009 Tr// 6311 PAUL J CAZEAULT — 1031 MAIN ST OSTERVILLE, MA 02655 Update Address and return card.Mark reason for change.. (�50M-07/07-PC8490 DPS•CAt Address I:_) Renewal [I.Lost Card Ca �- •-••-----�•••-• •--- _ ^s�' '"�!':.: G zc oanzmoor�u r• / crz• oard of Building Regulation•and Standards Construction Supervisor License License, CS 26325 :: n:�; Expiratlon '10/20/2009 Tr# 6311 vi"u Y'. %t i 13 S00Ctll. . -QO;.i -_ 't' -^. PAUL.J CAZEAULT,...'.: 1031 MAIN ST OSTERVILLE,MA 02655 Commissioner F7* ----- 8X H1-2 8/24/2007 1 ;21;48 PM PAGE 003/003 Pager ooa- ., • Fax Server ACORD. CERTIFICATE OF INSURANCE PRODUCER DATE(MMIDDIYY) 08-24-07 THIS CERTIFICATE 151SSUED AS A MATTER OF INFORMATION DOWLING&O'NEIL INS AGC ONLY AND CONFERS No RIGHTS UPON THE CERTIFICATE 973 IYANNOUGH ROAD 2ND FL HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO BOX 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 14YANNIS,MA 02601 COMPANIES AFFORDING COVERAGE 22LGR COMPANY INSURED A TRA%TA-r-R.S DIRECT ASSIGNMXNT COMPANY PAUL J CA E-AULT&SONS INC. B 1031 MAIN STREET COMPANY OSTERVILLE,MA 02655 C COMPANY 0 COVERAGE THI IPY ANY R OU CL'gi ENT,TER THE POUICIEB OP INSUR ,ANY ANCE LISTED BELOW RAVS BEEN ISSUED TO THE INSURED NAM®ABOVE POp THE POU GY PERIOD INDIOATED,NOTWrht9TANDINO ANY AFFORDED Y THE,TEAR pp CONRIBED E ANY CONTRACT OR OTHER DOCUMENT W1TH R81PECTTO WWCHTHIS CERTIFICATE MAP 8E CY PERIOD OR MAY PERTAIN THE INSURANCE PAID CLAIM. BY THE POLICIES DESCRIBED HEREIN t5 SUBJECT TO ALLTHE 7Epllt3,EXCLUSIONS AND OOHDITIONS OP SUCH POLICIES. lBE I S LIEDSHO O MAY HAVE BEEN REDUCED N PAID CLAIMS. COBY LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDPOLJCY F POLICY E=XP GENERAL UA13JUTY ( YY) DATE(MM1DDtYNI LIMITS COMMERCIAL OENERAL LIABILITY GENERAL AGGREGATE CLAIMS MADE OCCUR PRODUCTS-GOMP/OP AGO. $ OWNER'S 8s CONTRACTORS PROT. PERSONAL a&ADV.INJURY i EACH OCCURRENCE S FIRE DAMAGE(Any one fire) s AUTOMOBILE LIABILITY MED.EXPENSE(Anyone Person) s ANY AUTO ALL OWNED AUTOS COMBINED SINGLE LIMIT SCHEDULE AUTOS i BODILYINJURY(PorPer9on) i HIRED AUTOS BODILY INJURY(PerAcUtlent) $ NON-OWNED AUTOS PROPERTY DAMAGE s GARAGE LIA13►L,1TY ANY AUTOS AUTO ONLY.EA ACCIDENT s OTHER THAN AUTO ONLY; EXCESS LIABILITY EACH ACCIDENT sAGREGATE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE g WORKERS COMPENSATION AND AGGREGATE i A EMPOLTHE PR ER'S LIABILITY US-0095864A-07 OS-10-07 OB•10-OB 7HEPROPJETOR/ STATUTORYLIMITS X PARTNERS/EXECUT)VE X 'INCL EACH ACCIDENT i 100,000 OFFICERS ARE EXCL• DISEASE-POLICY LIMIT $ 500,000 OTHER DISEASE-EACH EMPLOYEE 5 100.000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLrSIRESTRICTIONSIsPGCIAL ITEMS THIS REPLACES ANY PRIORCERTWICATE ISSUED TOTHE CERIIFTCATE HOLDER AEUCTING WOWMkSCOMP COVERAOf. CERTIFICATE HOLDER CANCELLATION SMOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCO LED BEFORE to THE EXPIRATION DATE THEREOF,THE ISSU1";COMPANY WILL ENDEAVOR TOM.m DAYS WRITTEN NOTICEICSTTO THE CERTIFICATE HOLDER NAMED TO THE LEFT.RJT FAILURE TOMAIL SUCH NOTICE SHALL IMPOSE NO 013LIGATION OR LIABILITY OF ANY KND UPON THE COMPANY,ITSAG6NTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Charles J Clark Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. I(Print) L ); r<JZEN , -4 A&1 s 0, , as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job /V 410 Ne 00. C S-rEP% U 144-V_ Signature of Owner Mailing Address of Owner 141 S6'e'td� )u L Telephone# gd-g 2, - 14.E Date C z(Z.t1&g (Please return this form to Cazeault roofing along with your signed contract; It is needed for us to obtain the building permit required by your town, to complete your roofing project, thank you)fax#508-420-4555 .,� I_ �_._____-.-_`-1 1 � i I I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganizationMdividual): PQ,1) ( 1,o� 1) �-�' O- Ci `� �)C Address: J City/State/Zip: S 2N 11 MA Daffi5 Phone M 5p y ZEr 11 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with VZ- 4. ❑ 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 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp. insurance.t 9• ❑Building addition required.] 5. ❑ We are a corporation and its 1011 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;EfRoof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *My 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 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.#: U d Op t S 6 1p y No Expiration Date. p O O O Job Site Address: n V City/State/Zip: policy declaration page(showing the policy number and expiration date). Attach acopy of the workers'compensatio Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce i under the ains penalties of pe 'ur that the information provided ab ve is true d correct Si atur . Date: Phone#: C0 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 M TOWN OF BAR NSTABLE BUILDING PERMIT APPLICATION 4, Map Parcel to,€/;�j vF R Permit# 2 Health Division .10flu BA � AS rAgffi Issued& �2 -D Conservation Division 2 Qm� R 28 ptj /. Application Fee 0- Tax Collector ✓� C 5" Permit Fee y Treasurer z Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address �X U)c�(., 0 V �n� Village 0�1 `I-e�U ill f Owner W j2 ffe.r� �I(it/ttiS��'l Address /V � L��cr ���i Telephone Permit Request ��' 1U`'� — �'f�'�2 ���✓� qr Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation D O 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 Coln �,U ©o 4 BUILDER INFORMATION Name ' _ Telephone Number l Address License# C �02 oZ `` __� Lio-v yr, ly- Cell tee 1 N e ffi,�' Home Improvement Contractor# o a6 3 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �-a e A DRIma SIGNATURE oxt va vk DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ! MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ,, < 5 3�U DATE-CLOSED OUT ASSOCIATION PLAN NO. k ^ -- The Commonwealth of Massachusetts -' Department of Industrial Accidents' 6Gi0 Washington Street Boston,Mass. .02111 Workers' Com ensation.•Insurance Affidavit-General Businesses address: a 5� ✓t �T city' ��✓� �U 1�G(ll �' state zip Ga63'Z phone# work site location(full address): I/V f a�� Vtf 0- �erjll lfe ❑ I am.a sole proprietor and have no one Business Type: ❑Retail❑Restaurant/Bai/Eating Establishment working in any capacity. ❑Office❑ Sales('including REal Estate,Autos etc.) ❑I am an tin to with em lo es full& art time ❑ Other FI am an employer providing vzorkers' compensation for my employees working on this job.. company-meme:. 4 t r�,- •r•a + yid -•+el/••" t 1 4 nbone•#: .° '� 'o .: i .irisiiiarice.ca�5 '.� oh .#' <� I am a sole proprietor and'have hired the independent contractors listed below who have the following workers' compensation polices: ;:��.. ;:s^•' �•;' - •r:�.:,• ''L:; ems::;. °i �. :• .�,•7. address. >y;' •:�•::,.,. _ �: - ';;°>�::. .:i:• .i1 .•.0 ^.. '...'Li '•. it 7._.. -4..t� ',r ,•>'::'.1'• ''i ' • ••}:' ,1';i,' '�:'• ,fit.• 'i j:. •f• o7ic #surence co. •:�.•••.is•: .• •" � ..:.:.. .. �: _ " _ comb addre'ss:. insurancexb: .::olic::#•, - Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the Wm of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that g copy of this state eut may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby ce fy unde he pai enaities of perjury that the information provided above is true and correct Signature Date '-02� Print name Phone# official use only . do not write in this area to be completed by city or town ofncW LO r town: permit/license# ❑Building Department ❑Licensing Board eck if immediate response is required ❑Selectmen's Otllce❑Health Department ct person: - phone#; ❑Other Sept 2003) Information 'and Instructions. Massachusetts General Laws chapter 152 section 25.requires all employers-to provide workers'.compensation for their-. employees:- As quoted from the 11aw", 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 mare of the foregoing engaged-in a joint enferprise, 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. f 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 l52 section 25 also states that'every. state or local licensing agency.shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.cammonwealth 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 t�a insurance requirements of this chapter have been presented to the contracting . authority. Applicants Please fill in .the workers''compensation affidavit completely,by checking the box that applies to your situation.,Please supply company name, address.and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department-of Industrial Accidents-for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or.license is being requested, not the Department of Industrial Accidents'. Should you have any questions regarding the"law"or if you are required to obtain a.workers.'cornpensation policy,please call the Department at the number listeA.below. City or Towns , Please be sure that the affidavit is complete and printed.legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event'the Office of.Investigations has to contact you regarding the applicant Please be sure to fill:in the pernit/licens.e number.which will be used as a reference number. 'The.affidavits may.be:returned to the Department by .mail of FAX unless other arrangements have been made. ; The Office of Investigations would like to thank you in advance for you cooperation and should- ou have any questions, please do not hesitate to give us a calL:MM The Department's:address,telephone and fax number. . The Commonwealth Of Massachusetts• . - Department.of Industrial Accidents 8Mw of Mesneatlens 600 Washington Street Boston,Ma. 02111 fag#: (617)727-7749 phone M (617) 7274900 exL 406 l r _ °FTME r Town of Barnstable Regulatory Services 3 s,�tursrner u Thomas F.Geller,Director . M,►ss. ' 16 9.i' � Building Division _ Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 office: 508-8624038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section. If Using A.Builder I 1 I �4�Ns �. . .. _ .. . .:....,.___.•as.. er..of the.subje property 'A� iff Ian t o 0 hereby authorize _ 0 v i D -IA�IS • .to:act on=y..behalf,. in all matters relative to work authorize�•hy.this building•pesft-application--for.. 4 (Address of Job) , Signature of 6vner Date Priat Name ✓��OAryffd�6�F���U��/��N��tE�ULA�IUNISJ License: CONSTRUCTION SUPERVISOR Number: CS 062822 Expires: 03/29/2006 Tr.no: 359.0 Restricted: 1 G DANIEL C WOOD 38 E . CENTNTERVIRVILLELE, MA 02632 Commissioner 00-35,000 ct enclosed space (MGL C.112 S.60L) 1A-Masonry only 1 G-1 8 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DIG SAFE CALL CENTER: (888)344-7233 oyw� k\j 1 � �rI Jf >C,T' c,r 0,1, n -? 37Tp / 0b e � , i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �' ` Parcel Permit# (a(9(n �o Health Division KQLE Date Issued - r 2003,1` 3, l� G L Conservation Division_ ` 7�� it P� Application FeetG? ee � 34 Tax Collector �(� 0� d Ivy-'_ 1�_ / �� Permit Fee e Treasurer -- QL -DIVISION SEPTIC SVSTE6ti9MUST BE Planning Dept. INSTALUD IN COMPLIANCE TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANO Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address W k!a^nn> 4C_it Cif, ( i Village -les- t a- 1ACt Owner.�00D �YIQl1o42a/l Address /f� .4c �� User✓t �\a Telephone Permit Request ri 0 r- CA,, 1:2 tj u C) 2 X Square feet: 1 st floor: existing 3 ,proposed 2nd floor: existing proposed Total new er Zoning District , Flood Plain Groundwater Overlay Project Valuation 01 oazoConstruction Type MA J'Wrnr_ �(_4220CQ Lot Size , 13 Grandfathered: ❑Yes 'Q No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family O Multi-Family(#units) CDiuw �, I Age of Existing Structure I d Historic House: ❑Yes )I[No On Old King's Highway: ❑Yes O No Basement Type:- (�Full ❑Crawl ❑Walkout O Other Basement Finished Area(sq.ft.) O, Basement Unfinished Area(sq.ft) ��� Number of Baths: Full: existing XA new Half: existing new -D Number of Bedrooms: existing new Total Room Count(not including baths): existing Jr— new First Floor Room Count S_ Heat Type and Fuel: XGas ❑Oil O Electric ❑Ot er Central Air: #Yes O No Fireplaces: Existing New Existing wood/coal stove: ❑Yes *No Detached garage:O existing ❑new size Pool:O existing O new sizellh Barn:O existing O new size "V Attached garage:O existing O new size Shed:O existing ❑new size J Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial l)OYes ❑ No If yes, site plan review# Current Use 0 Le Proposed Use BUILDER INFORMATION NamefAl 1 t?rl)-A C4,, a -� Telephone Number SO C) �5_33� Address'� a;Vy License# l 034p'r✓i/1 P I YX a Home Improvement Contractor# Worker's Compensation# r ALL C NSTRUC 0 DEBR RESULTING FROM THIS PROJECT WILL BE TAKEN TO • /r }_SIGNATUR DATE _ I U�—© i I FOR OFFICIAL USE ONLY - -PERMIT NO. I DATE ISSUED MAP/PARCEL NO. ^ ADDRESS VILLAGE OWNER DATE OF INSPECTION:,'- FOUNDATION FRAME INSULATION z FIREPLACE. ` i ELECTRICAL: ROUGH FINAL' - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL, FINAL.BUILDING - 3 DATE CLOSEp°OUT ` " ASSOCIATION PLAN'NO. 1 4 i i �': ' ✓fie V�ar�vmaruuea��t a�✓'j/�auac�t�utel�s . ._ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR a Number: CS 077873 Expires: 05/22/2004 Tr.no: 77873 Restricted To: 00 TERENCE LUFF _ 832 MAIN STREET . % OSTERVILLE, MA 02655 Administrator i I The Corrimonwealth of Massachusetts - - ,Department of Industrial Accidents ' _-_ - - OfBco o/Inyesti98t�ons• - 600 Washington Street - - Boston, Mass. 02111 F®R`3 Workers' compensation Insurance AffidaviVIM,� / FMMM Dp p ante: .. ocaiio-ry _ � l0� �• hone# '.����. C!��.: all work ztlyseIL ] •I am a homeowner pesforming ] I am a Sole ro et or and have no one wolkii in c achy ////%/�/Noci% %n/%%//// %W/o/%/% �jobb//%//////%%///�// orkeIS co a ?4?:fRX Ct; "<$�rF"" fin'-,;;�!`s'€ ri' ''{: ✓>2 i";>Sh,;u.. eTT1T71 nnioon VldlIlg w n :. Sys yt;.fia °S I-am rr ${ ?:oy., •# } •. ?F22,4: ., t Yr t;, f'S{k} 55:: '%{`,. ,f, 'M]`Y'Lr{:r. ]' 'nK{r'ni;„ ...2?r• vSr, f` Y. ,vA f?r. ?, �iVL+?'^4,�:,.•..R}✓y>1:r,'r: :}%'•rn ,L., .......... ar..YvY•. F::` .??•a?• :>cic%':';> 2 .}.;; v }•• 'tE„s. .??4 KS? t ytS: ��3y, t;{ro:•} ^L:f;?H a S•} WIN 4 ': fl:'?•.v`/.,-j: la' ;}i `# r yM1y c av{ e?.§l..r F): ,. t{£}a rY $ ? ,3.t :{1 r.,: N:�' 7•; y3•;jy�,r.`>:`:'.; .,fi':SO.r: , ;,. `?•? ry{�.'•L. ,aY}`r ''?h,: •h„•.y..?:.,'•i4.2' {,�y,?t)'•}�r.?.,aT.f}i,\'�:L»}3.�a <i;:>:r•. Y. •:'?�$�:•r•/.; t•rr:Y{;r;;:rr'• ,:?.. .a?:.ir^rf:: 2/.' ''';i7�:�?$. :],:. '•ia•+}:},?;;•;$: t;ol r>:;1:;`¢: ?a:•:c••• ..•S>•::s aA. .erry .:•t?]$}•��{:}`4'u•:a:;•R!.Y :: '�' .'v:t,;;.a}S.#,• .,{{ :;'t{�" ,�• :� •;},-:,.vr•] ,•tRi} •':]{f^.`:Sjin•'S;.;:}"r??:%2.. ?:)..:-.`{.y.4na:r.,•:n• ,..Y u: a{.'n y`�`3? :}��� };,:?{o;^:"J'{].:;#„?• ¢vc..:x;{..i ;C., y..,i,.: ::2:+•. :':•]Y.,•,. ,.V :w. �##;{' .{,•y�..,.:P:•Y'•2st$'jSi`;"- '•42:?;tt?`:tS:•�:�''} 4"R :g :�y.. ,J ,.a:2�aS.L.{:?:^s�••�;i,•}n gTQB.• 'S.. »r'r+a`.yr,.'E?;{F,,;:�}•]u•:#?.: ::S>]n?•s,• L..:xi1�,,:#;?,. ;;Ef�r�7;`:?+:y 'z�.•>5§7$l..ai:{4;¢":'t r`,s; .raja .icc••7;^f••:t�:C:�'r`. 55 Sn••Tti SSj/.• j ] v7. S}y;a >;{ 1vSa. r .;. :nw;,:eti " }• .x•:.. ., ., r. fL}OIII ::..:5.•••,;�:'l{2:? a' ';tt''•• „•'t .•}:: -2 ,.37 ] :.,4•,. >\.vc 4... nrr.'n:{:•••f?•? Y'»:$S•.'•':L'i;£:, ¢'. y;: ,y}.}r•:ar:•i..., ]:nr 2X}„V.y:::• x' ro`•.r +�:.c;+f:^. . ••2n7:•�•#x•;:>o „K:}i`u.r;...ir/.'.:•` ✓h:: ,q.Tr...�if➢{:•{`K?}?I{••j{ !..} ;a.{yv. ✓•'4,':;•:GC•,.t •ar.,,F1':\• '•. +e 3•::e.,�`!t}• h.'-.:.v.nj. .:J'?dt•S:##:%'t?';'�o ;t,%::.:J, �n"r..•1�.w, xr•,A',•.+.u,Ys�.p s\•,.?. �;?•�`' ,,,,.H, ..J "L� y �`� ,{ ,.� �,. {} $:t .Y '?•,�• r. dt{.?.\ '.}H!,l,';?�.`?:•':h>S.;JA?'nO�ii;:4F{,:r?r:.}S:.ar }.]]{,:di.Y:•.nY. •r. ,v,.,; .y y: 22:y: {S}$ S:%• T.' 't;$`:.H _�••tF yiy; a.{•.} :.{y•, }a'ariiCYr,•.a f?:'' .'S !{?2.::i /r }• 'U " ,•SY;�..C.t' ::$::7..:. ..,y,.r.. 4:%'n;i '•x{•:'::.v.K.2x::... n:y,c,H,+.3.'•k::,..a...£:<:✓t ..L,{.,Y ,L Slt,• ONE.6+ .:Sr`' .? ?,4:•>:v; a%V•'.::Y' .2>.r.a. ..., t. i., :r ...... �....... ...,.::,.,...;.. .r...t::•:.:'}x::•;•:':fijy'$•{'u•:{}':Sj!•E�>r' T v:;f?.!. #�}:�x.]3: :`.?•.?,��.f.., .K3?%s:�:�f: .y.rL;f '�•Y' ♦ rr.;},A}., ,/•.,•?y:3f7:r xGs:s:rnt,•r:r •,•,•:,!t-.x :HJ..r;f:°\, :,•{,e ?': t yam,{.- .•:2'•.�::...x{6�i{.� :.a'SfS!tr•Sx� .:.�:$?.,;,x:;....n`S,',`}'+'• .v>Yfr�fir:?'•Yi;:•'•:?;:<•vi'S) y:.,x?S;L?:•),:;.;`.. `�..c, 'fi at. •. :W S::L:.tt:.,.....,x..• .: � `i ]: , {,..n,:•n:v r, rLY.is •,\, + j:•n i:? .}r:',;.•{.•;.`,4i'"4•'44}.4?}??yj;;4,: :a(��� :q\ : �'f:•••;}':}�.5:2•Y}3.,,• ;}...5{:. v fy{.. Y.v ,.Y. VYC'j•}:n: '�'::•r ''.`$�;�.'n v v•:{ rY{r' :rfn, v.i:• ;v.Y;;:y�:� }Ct:{ -9. a'i:•.? ,�v. /• 2:}`•tj ...... ..:....:, a•�.:.;-: :y.•. �t<71%•, r::•. .. ,•.fir...a:?:'�•}•}LX�$t%'tt•,-. ....; . ,; :-fs}.••• r•.. :,ir,;?v:S?:#:'i:'L;..: {<•:•:{:?�.r,.. .>:�>}?}r:t•!4:. ':a :4L r.,.Y:.;L.;, r :xGt•5:�: na`vY.•:Y7;�•�;s{: :.,!x•:>•{. !:+#2o}}f..: ra,:,.{.+t:3.Y:.OfL•S�~`�: -rs.y .e]{.}:J},».>:•:,C•. .4t }�!,,...,§�:n:•rr.!F,.„/¢.xr{i:..•• !7h: ,.t.]};:.. ;»'{ # ;vx;..{:{..S{S%•• y.•, -� }..ir. rt?';•4. rr 7r4::::•, :.r.;•f. :.:vrrrc:{ $i;%.l 1•: ;y' }}{}},.r ,•%�. ..:ffY3# •].S,•{; , :•1.,..,?Y. •o::,}^.:::..]4 :x3•�raja:+: ... •.{,•.{,:::-}i:f: t•Ri•v:2}'.; 'cl:r{.{,,,?, 'fIN, .r.a••. ,Ki`Di:•flr:'"Y�:••x'•;a}•.f••,.•.'.;>r...»•?.:.. a.:+ •��� ,3t ..A.. h„3.`. }. q 9K#:•d +ij::'. °:$:�%.f,•:${ES•S.`N,r, Iltl�•1��71•�;::;., ..o*::a`. ,r... .}. .?,{:?�.,. :•,v 4r,•hA: :'r1.•O:a rQ ,T••; .� •nS:r•,N.. {'> ' .x(. r,w;••y v.:t{t•}.`':'i$�?}}:;F,.,L?.; T.`\\i?l'..•;p?-• {:.:L.{ •:.a,:n rr:+!. ':rr.. tt..S,,.,w.,.;. .'•::r <z3:C••`:q..�.;;k,,`'. 3T x• f,.::n .rt..T.]"•, a:`ta:}•r. ..... ty:y}ra,;.2:?rtiSf.`..;;.•}:,,{{•,;:{';. y..cn}i':,`.Y•:S'••.,{::•v}.2•+ t•{.":'k>7•n•Y� tt; 4 ? :Y4:ra••: +:::•j$?:v:{;`•$ .}.:• :.'::?•:•, :Y;.,`s.,..}..Z.y ..:v'Lr,c,r.}'Sa:?,: S•... ..}t;..'K~ `??Y+fi';},r•;o ;•YY:•`.; .t•^- Y. n).:;: Yr:t r h:i't,+.•4Lt,a{f:':`:,ta}. n„r: ]i:?•. 2 r:}i%'S.t..•. .a•:Y/, {•. // v< 7. ::Y•r...ri. :W.v •'�.�•. ?"K$+: ? .{?{n,},, a,`r.a:e^' .i�:::>rr :•xt:L:r{}n�^+?''g'{Y?'•; r.iv n4.. ?{..✓v' ?�1• .i..f..nrr•r .f;l. ?+::t>` .•{j,\P t.�••r Hv. + �.wa• rr:{.;v,,.e N,{y y�;;r ,�K+}::}.?'af'i;.•... •r.;y,;$. E.. .c.. .?a�+c...an• ,7., .4v. f :R{A? ,}}.}. }. 4..}. "y,:.Y: r{?%+j]•??A4:�R' v, 2-:L•:1'}`v va�} r%1{ .f}•?;.. s,r.. +�:'•: ,:r• `"a•: `''�r,'•,;xfC':`:•: 9{'•0. Y:..•. :ir`> %'}�5:..:rS{{;r.}. .:�.a., :{{::Y:•Y ..+x+?s,.7%:] :•Y, :•o:l+.}. .,r•{.rr,er.. S'•:j•: 4r2+:: °;°a.S. ,a�ro••:$'}'S?:Fr'it.: ..J a•k• ..i..a?y.:, e??�,V, .fSSSF<:y;n,.,::::.t •,•Y�.�. •Y•':R2Y•:A?,4..h., {.a F•Y .:.ili!} .,.1,��:...,f.:,+,.,¢..rS,�;.� 'w#r v?fw-!{•F }'W.•X}C}:5�•:r{ ..N22,^.;.•f$.:.w::•rn•,jr.;F.•a:'x .#+n::.:Sn?4tiPi:+.2 :•hYt•.:....x.:...,: +;.✓r..y;{ v::,?}y,Lv✓nr.$ :�-,n,N:+ .,;f;•..•..a .•,...:3•:}x:{: n'.��cc: 3,f,., -{;n ,? ..tn} .,n.:. ..4£r:i:•x•}.t. {{]::k}:`•ai; {.,Y•!+#•:}.. f.S?::Y4`{H •' f r...;t }-.:.n f.n}... } :R•., .':H:;•:.r .,�..; ro•':•`k:r�rasCv?}i:;:V{}:6}?n$Y.}I$Sryr}:;S.v:<2Ck?{?�,»t�%l.•P,.hy',,`•?t Sc�:�j?ivf);:;:;:�n}:. �i1L`'�i: �tn•°};'i•$:].•.. :j;':•;n?:.>:x}a:'t?{v S7:!.Y:r.:t,:{..;,wr;.aK•.>r..;:, , r t r..:::....n•:: f,;#,...r•:.....i::.i.:j. ��1517Z:21IGeiCP r::.: lt+ ].z......•n. v::r..r..LY.•}:,:;•}::: I am a sole propri r, general contracto , or b omeowner(circle one) and have hired the contractors listed below who _ haveensation Ol1CeS: ^`{° tC'{ OL1CeIS COAL F ..}s;Y}rF.rr.{•Rx!P}`], r{,n•{t;n�asMx ,{.:r','•;tt"u:}?::i;Fv;? .:Y:{ tia.{:L. % ]rf{?a•,,'S{n''•'vy,';`,,,>}} �}.!2 ::.: ;nt'•i v;a?'t}a, + :t r jjrl:.,;n2•`:;.; q•:$Y? :':J} t fa?Yt?{$.}s•yati:•? Fa:•a:S xfy!S'., `Lx,,{yc'K faLa{R;':t the-following ,K H?.a:!. ,.1� :?:{;6RY•n:v}a} nLtj};.}.x•4},+':'3}fKj•,#.•`.}•l•+:n;;i 2,.;,; {.,#Lr.:r. }4,:? t;$. v}�•,v r.},• .J4,•.:nu..5 H•2,. .,.x?.vJ:Sx}.n,. ..✓$'.'•. .i~.'r..` :..r.: .rr, ..rS rL,.}•.. .,.',t?,:;�•.•:r xttt%jf5,t•r} .:}>v,:t.p.}£+}x.:•T``.::{ :l#f£•. r. .,.6.. .a?a�?vS:2;;9,.j`+tro.; r..vy+}:*:•f-N.O.v:.. .h.. ../rr`i,•,.. v 2r:};h:::f•.}?`.•:•}.t.%f'F,•,•'F. ..:rT:•y. r�.;.; :.w.iaa....f. •:5.:•'::,, ..j7 viys:::rn•.{.:rf`.L:.ry�r.�}•r•. f,,}y; ••Y r,.r,.H,ti4 .,�• .rr.;s,;:.:•.. ::i?•.4:+4;n{�4 r:.:;; j^:v/,.}.r` 2}�l.::`••. Y S£:=� ,a•., ..:Y. ?.: : Y, k'•Yi•x�,.,yn;::;:.}•.}}:: ,3,s?•#..:tn. ..} .:.,.v..y"r.a .{;C ..4-y. .5.: .�;%.]•hY2.:,.,•4S:'.}•7;ffw`.:}:;r:�.`?.. ,�7£:R..t:•.,�RO.:?•r,.;:;`.'•$ ., }:{•: :f,.•+Yi•`G:j':r+.:Y:+r:i:.,rr,,#2 n .:.n.. }, ..r ,>}r:L::. nt.; L•? .T. . ..v •:iL•.dY....+ n.Y,.r r:.y.;.�.: .Y:?•?: ..rd n.:Mo.:x++?::rvna; :+,ny?},•?,.S{yS✓:`.E;: •'rS»};r,•:r.}•t3,':i:.i#:: "•:R.:r.:rc....G,...f•??�5:;•iyS'L:•• All •:., lr : ?'�}. e•:i>•r?:•..• •},^v:}` L .'•I.�n•` `•:.xr,.,- ''?:y%}?f :..f.:n:... .�t. .n•?:::.. r .s:!•;y:..!t{.r. r4•n•r. ,r :.; :5.: ..e• .: .. :•... � .) .}}Y•, /Y.:. G.7:.+,•,.L.Snr...o£:r•:.4.a :.,Y:••}Kxi•:H+.}::%,to},ya;F?•?•SSy{:?'sg.:tr' nr�.':?rr>,Ya;'?S;•'.�;::M��3�. a":$ '•>: , r.)$,n;;:S^c; ::::4✓}.#:.:Y.. r)'r„rSR.ac,•rr.,:: •:ax•>;}:SSY 01111 rn,':•-42x:vFrci , :?>;?";3"i•v.'•:y']?:?:jtj•r,•ie✓,r~+\,f,'.f?` 4...;,L.plt+::^i}`:'v:.S\:r'•.}}.{ } $ IF%:bf}Cffi:2? ?l.• S :{•};.: {:r. .mi S"M F::{:•"•;T;r;:.>• w ?.}R'. ram$ yf# L :r:;< i;r•.gq+>?Y?..e..+1.4 j T 3 +•k •#fib .:lv?:R %••K•i:6$ f�(fI17 .3E1..::D 'r:y+.'•:'r?}'`' ::»}, i::;lY]. •?.H.a`?+`:f:•:?]•##s , 1F11 n:!c c .,r•r i••m.•i:"}ri}:y);?.:f?. ;,.'4h..L..: :.>:,a:.4.y E<.{fr:3••r:XtG?•`<)¢:''� ¢ ar'i,' ].r. �4 F• •.}4-r:. } C ••/.�;.i•x"a:`\.•. �'br$f .f.?/ Y/.J: :£?#.}:•+•,•, :`:t:.:, x.. ✓, tF.. ::�•Y•!.�L,..:p:?i•.<.�x{{t{Sn.S?{"'i`,`frLn..S•S.o-;';• x��•L£:>l•}'}.i,4�fj•^t.nr.. `..�}r:'.S•;}>p. {% rry ry$?• Xr,:h ,e •r::,c.:}:?>:}9rr,'F�,? `.••?•3}'.t,'�.,, •.2•L }.,` �:,rSZ••:r{p•f..l ., Sj ?S .:Sry :Y: c: .F?••:•'�}C,.t♦ r .ti:..PS `{??}.,yh}L. :`rnvlr,rn•rnfi. :v.} l•fr. ,'r.x.t'r{.n,x.. v.rV'•':!i y , `? :r.i.' ¢J.. y t j??•::V• v,}•fi{..44••Y 2•:Jfi''vF''iC.r.n #+.av::�e.?Ln]r.?,'fiS?{{t,. '. >.vni•.y::.. %.::fv:•:.:..✓. ,.f.v::!.. r.,{t?.{{ {'. a <•r} Y%y7�rh.tir:•lYYa•yt?trx>;:y� l...;SFi•.7•.. n?'^? .}S :{f3•.f'} >i:;E>a.:.. •.¢, }:]:::fi�::t.aw.,.n.:$.:Y ..n f,:.::?>.,r}?::w.•:v::::jF)).{{?: ..c,�;:#':fSO{•f,++.,.<v.3:{!r,Y a]:•}:r 'v:•:n n{.,;r.• ..j..;n..:Y a'{ta:,./• { r a].4.n f..............rx,. .. r.:•:}::ra....;:{: .n:•.�:.aW:,fr:..., ;G. ... ••;:.{ }...,a r...�. Y. ',l`...rfaSi.•l.•.:...:r .tr` :,T..✓•.•. ?•:nr. RHriY r ri:}::: : .}`#;•.Y4,1.... .... .{v.. ,?a::.T•- ,;:,¢•.' ,>,t`:i.,. ,..i i '•ryf:• ,.a.. -Li5:4>o..x -:.:tt+a•x +•%]r•r}.`•r•Y•v,ya.:j;:.:.{};:$S:•::,rc-,;lt,{,. {•:Y$'fS•,..:yyst?...}.:+;x,4,. #C•:!•..:?,....}]. t.- {.n •a•,:••?-aK�.;;:,;:{;P}y};`r?p2K:•y:<`'"•`•g?i#,'ir.%P,:y,?,,•{aSS{r.«:S•::ri�••}s}:;v`..•},.;,{{,:?F?#:}:f?•2}x'•'-F�•yo 3{ :�${}{{••Yi•.l:.Yo. •::]r.2:Xc a,• F>S:•i'rf{$Y{ ;:py.(.rC. X•...r1.{Aw a t,.r � ;t'a,• .,.,:y ,rr�^,l.',.';: :isesg.:n? µ}..S?{>.! } / . t . yf yssi S•}!Y.{Y Y•. F,;Y-a8s n.,!•:; �$d 2r✓ } :4r.'•+ :Y:n..,•`}R:!:.rfi/r.:a x:,,,.^ta/.:t?,E?•rrr^Sf.Sr, :f,^:} n}w}.#iv::]. :v:H•r r.2:•:{••Sx'nJ•. Fu. 5%r 't+'fo>Cj�' ?,.i"}•'?']:,, }Y.•:2Y:} ,yO,i:i Y ;X•�`v'•i'; 4:Sa:'e•?'{. ..:ra:•r??C¢'•iyuw,?'`: •'£�S•?%`9i•'�::/>,F•L:::, .nra,.,t... r,.l : rr:;S•.. ni.,n+ir�}:c•\4 •.{,r •. >::Yr> ;nrS...rah::,•:,},3%;.y.rr!rrr.+.:'••r•:.:-n'ry:rv�. }S:o•,k.+ ,;?#d::.r•.�.a xu.';{{gfiY:;;>'.? ,,,{.. '<•,r.;a./' .?arP },•. .G:<• •N(H .tS{,Y f: t ,•ivy,'!.'tf:v .a> ':'•;!G:2y., {S ...]. d' .,:+1.:•. .k.: 'r.•};:{•raY:, x •�+r,} '•'f,N..i`,`•';fr: ,k{.,.yyfy. ✓J2•{•5 ,.:TtCH..r; .!f.y:r p•#•',>:;' f,:?4.,+3.,tt,. bcY.�j`,:r.•:it�'%:�:'•:a:#.<S?r�,..f ,}p M?✓•. :.ay,+,.^'>;f•.. F;e:.<q.$:!.C.:t .,fi{. .,i2•{.c ::»,c✓,,r7Sfn:r,1, j..n,Gr G„9::•?. r::Y., ?R!': #•. .•:•r',ln`r .xa2r$ �( s:.n.:... .y.. ::ai]`:?• / .y?'. sy ? : Y•'y` Cv}f vi :!, I !M L�• OILP:M {y•..::'✓ " S;vr r4n{ $: +:r...r }tf:&'•: y�.;:••...., rr,`:..5.::3. .}. rfdf:!Fn,L:?: •. a• •;• y. :}f•. ?: r!n:Try•:„T}.. i}.n• a n.,:?•. :.o.:••r6 i..i..::.:..y,•. :•o:ti?'(+;c:fir..;•,.<a}{}?»:•?}:wSy.;T`YJ'. ..fit? }]$:•]S;R%+ ':'wr. ..t,. >. ✓r.yr .i:u!?}Sn•:r, ••:aYc:.]Y>•••4:r ,:{�•f}:, :tri. y.? ... ';-•`'»•:..•¢T'}r'•:j i •{af• Y....ty ,''.,$`+,rf..•. ••. ^, .,.. .,'.'.. '..' .;%}n S:r•S'::`}y;:?"•. r..,.; y}?%¢•`.r.{�i ..;?f3w.n,•,{;,,4;aa:✓.,n .C. {✓a?}.{}S^+.!T'`?Y']i•a{,$^:>`ri?••`'!1t5,;/!✓{:;;3';:;;.t•:,,.{t%-}:?y;C;•.'.'•Y'•:a }•rY�nn� .:H.r '¢j••/,4�4}-qto K•..✓x•W •:S}::., ! H yvu-tyyY M1„v ,`';#6 •y'uw,l ji}}!rrr>y.2^?•:t?•?{,L••y.:•{.7r '}:•r•f••.fir:'{r�r:` •}#y.,,>} ,n. /,7.1^,is;•.Ys- .2.s,�f.•}: t r%23 K}lfyr,,!'y:'y'"�'%: ,a¢ {S .✓,,.{ft:..i+::/• r•L#: e ?$„pp.yS•.:.# . F.n,,,,}.rr.i::2 '•+.`:.Z;? ,v.•$s. .:. Sj.>,;,�r.�r {•xi%}:j:.G:s'7.::L. ::i?r S;t?'+.•{�f:S:y; t .. .:.L }} n .:•<:$;}.-: :.x?,f .,aSvf•Z �::• ,j 4..::.,{.::¢S}X!u.: !t •a`,2... {b},t. _ :f.,fS?9: :` ;,{a,•nv7: ...l Y' r.,4v%»ti;N .yq.r{!{.r.2Ln'£'•7:{•yi,r. .f:• 'S :.,.a{•:t. .a•.;HK;+ fin{•£'t 's;Y,+'{'r`,.!:iP»+r•., ,::YS.{J• rtrss.yd:S?•] .'•:.r,•..4/:C(. 'oR:S }} ,#r fb;,�:.y. .$ y:;•}.;:'' ;•+/n}r:.iS•f`+.o.' ,::yF;.,+• :•yS+yarn: ...•�•S j;.:y,;xy Ycn.{#}t#>{y.?� t& { {nn:.:,G•tY+.6f.•::F..•n, Oli .jlfi±yi,:{%yf?G.:rf.•?'u?a:.rtt:.%Y:m}f•:.t:taf,.t..%c.....va>:v3.,n::.iar:i2r::yyY:K{yxb>.•:::::x :' 'v Y,r;E .vr ,}:g•?r„jlS•S'. _ ,' , fi i3"r.. t�.�/�1�//��/ # r h'+.}6•?TS�'%•?' j t:'t r'}•f.'•n;:<5f'i,.•r..}?rl .a• ..>:,.Y>.•,Si•}:• AR i1�f1P�28C n nw.td'kyXS%,fvfYS. <? r.•;•;••,•a• :`:.^,!:/••2 „✓r,?a:?;}:Yt '{:yv{j:{yi£;,•%y:vFt;?SiN,�E4?.a,?%tj;••'• 4:}.,'}?.'•::43'.A$SC{::'r.;:1•{$'/S`',5?t':.SSi�YKyt2,A.ata'�;;.:;? }`:s:?ta>s}y»,, `:y:`:#rrrrc}i:'+'y:;>ot> ,:.?.,{..}y...{srn.•!rr,,.r.:\:?•,$.,•4'r'bY�: f^: �tR'y r•.<#t?$?,:.,:.Y,S};,?]•f.nr:•;»i{t9f.�;:]{,y?F,y.,)irt:•:S{•H, •,•a•u•vlFH:i{{.xH ,• ;,. ..•l.•: ?,,,cf ikr�•„;}.:Jl ..y'y,\,"tiff,;Kr.,:r r•r.,:..:<] a {; .tcj{x?fr.,.,, .Lf.cv>:;t:.r:t :•;•f,:•},c':.a'•fr.. ;rr. rr,i:.:.>f.Jt•rX.4u�'oy^.2,.•ry nLtBL{.:.;r.:S s,t4'}:%r�J'+'v{.,. •.j:t' .:3$C••`c:%:� ..ic..•v.:•4,,.u.?,r:::`fft+:?:jjy,'.:r'��,: .y\sfi?,t:} ?';H:.,'!•{7/•.;,Z•},"Y!.?,t•:., v•»'{$:f$:rn,'+ ,r:fr:JFr.`f.,..:A:Sr•r a vrY.+v f-•l'+�'Y}:{:/T,✓ :•Y.,,.'t:.•!J�rritlrrl n}:fi;r yr ?C,•?•`..r�•}},{{3`•::/ r {}�Y,•Yl,.ry}yj•.•# :}\£+!r?a '"\:naK;:?n•:}i..r rA'JrY:HJr r:ai'?ylj'j}. •i.;r.} fir: v:+F,V�:?}`:::5.{. .5•}::q•.,<.v,.{A.Y.•... •nR^,'n?}• nJ•f.{$:..}.... ,,>f•Y'�' 7'»„•if b`?6!:`:Yy:.' !•.a.,.'.v 'Y.L?£•:F......t5nG,e.`^ 4:.,,., •r: r }?/ t +fix+. f y SY. .r�!nYr` i.... Fn-M`:i @,}•..an?2S•Sn?:•?r..,:{•::{;a:.isar tY:'tCTY};.t{.?`{:':: ,.,51r,.{:n• ,^..>EF x.?{.4]'?::alit,nSC:Crn✓{{an S••;H••.''tt,:v'.;a..;,:y,..i;.. ,v:k rl,•9:ra.L• s'•>f,1,:.E ..4•:,.+..tS;:,v.a;,•:.�{ ,;+•F. ny,.}J .{:x• ,e{;:-- ,\,'r.,:yi»ry'•',•'t??i; �{:G /n. .S'•.. ••r............r.. n:2•}f::: •:.?.::. •' .),..t '•::. li'�y:.Rra.. :•.r.:. v...]. H..r. •7r...:..�,,,..j( ... 5 : ::.... ,:r t .•Y.•.:{:n....r.r..Cn.. ..::iY.,•v:•.r;';:+n;rr:f:;y;r.?:K;. {2�.{ri"'r}Y'r:""'}L'�#'<`,:°•Y:�».£?:•.>:'3.;•:>3d,+,+;;; r' r Y.• I"'x:i:tvtv$r�v,[{i:ahVyirrA' •]\??'S}fit{,•yr::t ii' i yv >'F.f•!¢x'!'f vra ?,Ch.{.;,J.}Yr}n• ,Y,'.f, K,: taw.., ..tin}y? r?af,. ;,• !Y'Y ,vy ,a., v:2•r.r r a;!r„2.nrS,Y ,f wy;x i•{}Lj;?{{y;W;r?h ;:4 .r,.jrfi.'?,.''' }.7�• : r:. ;: .,.. r•rrr]:,,...a;yxr,.t..: r:+ _.c• ,.G rrx,:•S ,:r7r!„+,;!,.?•:y{.:...33y•: ]S r.,•},.•"�;^:Y?R;na:},^�•23.}.'a... ut..�.Yr,,]•S,4}r✓••{..f45�s.S;•.:n{...1'•..:r::r.b::ry.r^h'�rrf�iry�:t N+Y•,}..,v! �:1:'•}: ,rr;,.:::r•�•r r .,•^?J°., .;F r:FY•.,,:�v.{t.:?•:ray},r.�a"w. }4}LY,,jj R;. r}. a �.;r�•. 4 r'a j � .:jan.; ..✓,r,,r n,y f'i:`:; � t,+`•'4k''�.}.:a#,F:r.}f :r.�x•!utx:::.+•sc. .S v;iF:`Y`-. .,!r.-}, '#'+:`?f'. rr,! ..x:/Y. :!e S.2 v,.h;.?f`'#%.tf:�:�eYr v.{eL•y}r{.#:?nE. .s,?�;�i'?S:s..:�✓%.td"•'}'•;:2'C„ sr<"•v'j'S-a:`:»`??�K:EA•rr.: r>•,•}7.::.:},:y .r:•rr::.,,'+?•no.✓-.?�,� LLL{,?:'i�? t is::?`^• niHt�.a� 6p..�..r <:r,'�$.tir. �a rr .:a.::3v:.�t•;,}a.S?.r ; r+Ska::`�..:.of.4{:.;.j!. .{' ,..ter!}.a.r r,..�;:•::•u{.S;Hr ,•.Y;.rr :G,, r,.�nf?f.,.:}.tier»jj�>.:,?.r.c.ty{3':•. ; r..a.tr ;r.n+•$r:.a]• .r:.,¢!vN--.,. .,.:,}r n'+.t?$:'^ a•:..:nh...:r. :: .:... ,H./. r. rf:• N+ ... :,..r:::•+•:•v;...,. .r.... i?{{Y:i•v:.;vv, fi{-.+i.,,••r,f::. 't:Fy Exyr.�•#Sri?%...:'S In... :.. ... � �:a:+{:{:-;r?.;;} •f'.:v,:Yr.r:.....:`:non :n•f..4 A•:?, ..J?.ri•rr!•..2:,•a•• .!+„{.K:: ... ,... ....:F .r, ,r .,'n.,..• «:,F,Yn• .:\,n.{.;r...v.r{,:•f.?'{+f::.a:i}f. •:,:f.... a-n,.n. •:x:v•::v;:. »+ Y•Y.:itr:K•n^}Y.;``r}${?r� :•'-0i:''::}r:j$;r y'lfj•an''S#!C{:i>.:�v., /..r{.:{:. ./.vn:..,r vK•......:•:....: ..}. .:..Y..;.{:.. ...;!•r.n,..+.::r.•r•>:.:.. H,{r.... .. ,r,..r .. :.r..i.. ..r,. 4' -5.r. ...fi.Y....r.5.. ......:.,•:.,.:..}}:;{••' }ia:c}';:j:??"i?;:a.;•::t;?;L•+•'r.+:7.'v:f:p n2aY. f t: ••{2}u•x4.?:•}v t. .S.t$}••.:p r3'•::$,C.;;?•r.•��u:. .. ;;r..i..a.::+::P.:r r,.,•a.S•..iuf.:$rr.+.:..:......... „•r•::n•n,•:n•:• rrr:,•:::n v r.,;' S>.,.,:}::.,•' f` r ! £r �...r,. •).,. '�::.':::.. ,{J{.;.}:aJ?t•}l.•,r:a:??:•}:t•}s. t ....:::•::�::::{?r;...;r{.:jj:r::::}':::•.:•.... a. :.... .3 :3•:::?';;•.,,].:•:?::.f.;r:.,t�?':?•{.{}•}::::yf;tw .. .:.:?•....;.... .... ... ...:...«.:r...vr......,c..:$....xi.].:r..r/.... .:...,r..•.:•.. a:r:...vfir,.. ....,:..:,..•:n•,:•:+•..,.,. .... ..•,.:v. •.:•..:•, �e53r.. ....... ..,..r.,.,..{,...... ... ... :.:....7... :r:.r.:.?•:.v+•rr. .:::•::•..r....]:}?••:..:r{..::]::...:.,•::::,.r:..:. rrn•:,••.:•.,.. ..... !•r•:.:t?.r. f ... r.. / .. .. $ .:..... .,{. ....n r f ..... ..}.1. x,.,..:,. ....K. r.. ..r. •-?y::';•:++'ri?;r•w.?+r•.,{irN`?+iS:{••>,tr•`r,::Cn:;:?•v?:::•tin'+..n, L'+ti}Tj•:;\C4j\:•}# far. .4.r.Y...,{•.., :c;•n. ..t:t ..t; .,.t-::• ^!{.,5,.•?4r rn...:0:•R.. ..rk.•:::{,•...a`::•:•}:.r, •:L'as.,, ,:,;{..yt;u-••.,• :•:r�:•,•::•::}:v.r.r::{.!<.:f•{.;•yv.; _'::. .,.,t'S rr....:.•. ...:;{;;?-.}:;.{...:r ..r}:..;• r.'•].r:. .:•:•.v•r.•;r.r4h:•a:•r}:<•::.'•: •.J iry r.{.] .Y,.:{ •:{G,}.. .L.: ,.L: •,{e.. .i.; .)., 9.g ..r.e} .,# r. }....3c i .?a .. ....t. .. ....... .r.... .r.:r.:.:t•t•:. ..n. ..:..:,. "."?:;•$.,:;;.,..::: ,:;5•:i#'£S:S:L2+1.✓.•Sj$}Kr, {2'•}....., ;£.:S °t:7r. ync!4..#r4'L�•:..,,L.in,:.,,r:}4 .4.trrl/.•.r>�.{..:,.}:: :}v{.,.,ar,x:Sr:..ntj:.?4}•:}r{�n.r..:$5.4:.,...,,.?e:r FS hO�'7�:ii:?]iR?b.,..,..... .:. ,.,s}f:si:;. •...n}. •.,+.$,fG,,r.y..y�::rY,r:•^'.n..:r.,.:. :W'r•::e' •:.Y::a...: :.r:n•.,i;,.:fr,.-.{r.y;,]n•:^. rut.t:tv:n:c{}....x... :.s;t: .}y 4...r...v.'r::n: na:.. 1..,,.,r. .:f::r`!:.+ .,.{fi.:.:S,f.:.. .+n,.{..::. .::x?c•:: .,.r... . .: r. , n.. :. :.r? .a.. ..:?;.f.n:•h:.Pf....n. t•,..f�.;;r:....r. .;.,..;.. xrrt•+airi]:a:5,•r,•>.+r,a a:?3.2:, f.}!fir~ .• r: •,%•.?•]!r r... r~ .xr,ty):rNra l•:::rs..S,G•n. ,• t k.S ! .nor.}:+.:•.:..ar•: :,..,..r..,..... ?4 v.y..v:•:•,..,.,.#J#:•.L . £r'yf '<%f ;v-'.•Ya r�,.:t.... ...St.✓,r). S!,.; {.. rf..,�. r..v.r........ .. :;••:•rr:•:nyLix::•:'•.. {;�r•r!/9:y;t.,. ..:� yotS•::t];.'.'H:;�}•' >S¢fv: '✓,S•yti7:':..., 4 ti•rrvy:•r...ff,.iYL. < ?:,fcv.:.f'...rn: ro.:}• ^.4:t,4„ .:h•?.::;r?::r;.:•H '-:, ]::}j...1.}.Pv}:}•a::.�yb:S}xLS {.,,a. ;,$• ,k;l:,{r.•ar: >•,.a:, .vatic Yr}x'xY?`v:'+'i l,.F{•a:'•.{ :•y%$;;..}{S F,. :.1.::}.{.:2 "}.. ,:R._:.Tv ,r+S •.�J,.,r, n! , £y;.'{r�yy)r-.v.!ai:i:'•'. :L'E.••t•Yx•Tx:.• •:?H{afr:n.,# 1.,..; ? ..,•.,Rix +,.::£... ; ¢•{;•.b,;e •'?xay,•.✓.'#:s'`o.:-,p•.,yr.,�,`•{.t,::`:n••r...:.1?J'S. r.}4.,,,, •'.4r:...tk2?vS$�:•rr•Sr;.•%'•}' :..a:•%,;•: >3•f.•�i: Sr n +:t#i?``'n:S•„ .y.r:•rHo.,c:4S%1Yd�tic:??T.•�S:? ':a::.r. •`.t•r. •.t. ..� .t;iL?+y %c v.,•?:r S4F;y.•`.L,,j .,Y{.t.a.L;+x]n•••?;'�^.'cj:y:'•i??'' .:}r.•Y":Lnv.::•nfY.•.'r:-+.:.#, ate,, S ,� ',^'Y .�...:r:'.: .•r•:: :+ .,�?"";'v j`r.}•: ,f•o: {•r,2lYF. r...y•..] ;M,. j\c 1..R ,e.,.• r:f;' :#?`:`: .'•:•y;:. er...a v:+,. ....),• .$},{ y;J,r/.. lS•';,),.,v.!:••:,3,'.,;Fr.?j]:+:`r:L.r ? ,:, n•. �'•. .{ r:4', ;a�f ].; $:i}.. Ei ,;v? .h; :.(va.v/..,rt•.^•.:.^.,.... •:x7•;,.:•„v....,{.+.;.,.:F'�.,••.,/t•.,. •rt. E{rai�i.,•?.nji`y.,;rl ?:r::S?,j:y tSl.l =?ys: rr,#'}••70 •rr,r? Tt }{1�;�$?c :rtY:S•:4a:....,.x.;i,e.•�.r,?.$:..:..:ir3':!Sr:rr„r.. r -t• ..,..; ]]}r: :.Gr.>;j]a:nj,.`{:jrZ,.,,,;:;:5#:',•:.''•,'•.\yn-,":}iY.<}M•?v2•''t}¢•`:};:�`1:$j:K: Qli: ...r,.f.{{y,. ..).. '+'•#'tir.%�j'}{.;{S%YG•.r;':<'re,.4$,lrn:L�.; {yr I„S#r'• Sf' +YE$qY$y{?`rr.•{.:j;{;.;S,n.'•:{:}}.•r.L•^•:••:.+.2{.;:.{./.•:S'•,.....,......:.:. :�IIlIII�22C(�cc�'0�{Y /r.4,..:n•..t:.y .a. .. HERcure covera;ri�requiredtinder 5ectioIRIN of MGL 152 carilead.to the imposition of eri,ninal penalties of a$ne ap to 51,500.00 and/or �o eDt as dvII penalties in the form of a STOY WORK ORD1rR and a tine of S100.00 a day agairutme. Immdersimmd tksit a one years imp d to the OiSce of Investigatigns of the DU for coverage verification copy of this statanent be fo :: t - th�the-in ormotion-prridded. ue-islcua-ima-coirect Io hereby�erti he� d-penalties-of-perjury ff - _ Date � =Signature �, 5., .•• ��,..•• � ' None# - . print name `, ofElclal w e only do not write in this area to b e completed by city or town oMdal peanithicense# (3Bvflding Depar went city or town _ ❑Licensing Board contact person: Information and Instructions ' sachusetts General Laws chapter 152 section 25 requires all employers to Provide e or workers' omthpe��for the contract ' " an employee is.defined as every person inthe s rvs y. iptoyees.._A.s quoted from the `law , hire-'express or implied, oril or e hip, n emploY�is defined as an individual, p ar ners association, corporation or other legal entity, or any two or more of _ �e foregoing engaged in a joint enterprise,-and including the legal representatives of a deceased employer, or the receiver or ustee of an individual,partnership, association or other legal entity, employing employees. However the owner.of a ... wejag house having not more than.three apartments and who resides therein,•or the occupant of the dwelling house of " anther who employs persons to do maintenance, construction or repair work on such dwelling house or onthe grounds or ' a wilding ppurtenant thereto'shall not because of such employment be deemed to be an employer: . .� •-s eJGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance 6r"renewal ,.,., operate a business or to construct buildings in the commonwealth for any applicant who has If a license or pei•rnit.to lot produced acceptable evidence'of compliance with the insurance coverage for the1rerfoArrnaa coo public wo k until ,ommonwealth•nor any of its political subdivisions shall enter y P acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting' authority. ,',::..' .. ' �. ,., .: •• •�,••• , ,..,. .. .. .' ". ..' ,' . .;.: .. • VAN Applicants Please fill in the workers' compensation affidavit completely,by�eeertificate of insurance as cking the box that applies all affid your avits�may be pply�g company names, address and phone numbers along with a _-. supplyingbmittid to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and ication for tlie permit or. date the affidavit. The•a ffidavit should'be retumed to the Should u h or town ave any questions regarding the'Uve'�oiiif-YQu b requested,not the,De,partment of Industrial Accidents. Yo e ol7tain a workers' compensation policy,please ci T ilie Department afthe number listed below:.' aie required,tb City or.Towns •- - oi` e Please be sure that the affidavit is complete and printed legibly. The Depariment fins p rovided the applicant. ce li heb Tease. affidavit for you to fill out in event the Office of Investigations has to contact you r g ding PP {� the. cunt cease niiinber whichwill.beused as a reference num�'er.�TFie a�davits may�e'r 't�•,. be suie•to in '-ements kiavebeenniade �,.•. the Dep eatb�`7°algal or FAX unless othei kniag ad -, a :r v �•�i:.v re. '• •'j ations.would like to thank you in advance for you cooperation and should you have any�c uestions. . The Office of Tnvestig. _, _�. .., t• please do not hesitate to give'tis a call.. y The Department's address,telephone and fax < �.,,._ •. The•Commonwealth Of Massachusetts ^Department of Industrial Accidents _ ' - Otflce of laYesllgatlons • 600 Washington Street Boston,Ma. 02111 , fax ff: (617) 727-7749 M .. . -- •-�-1 __--.. ..,.,., ant inn Y ` MASSACHUSETTS WORKERS'COMPENSATION ASSIGNED RISK POOL APPLICATION FOR WORKERS'COMPENSATION INSURANCE MAIL TO: The Workers'Compensation Rating&Inspection Bureau of Massachusetts P.O.Box 66006 Boston, MA 02206 (617) 439-9030 IMPORTANT: A separate application must be filed for each legal entity. This application must be typed or printed in ink and submitted in duplicate to the Bureau. Under no circumstance will coverage be assigned If:payment or deposit premium does not accompany the application; the declination requirements are not met; there is a record of coverage in force for the entity making application; the applicant is in default of premium for prior workers'compensation coverage; or, the applicant has audits or inspections from prior workers'compensation policies that remain incomplete due to the applicant's failure to cooperate with the prior insurer(s). The earliest possible date coverage can be bound is at 12:01 A.M.the day after the application and deposit premium are received in the once of the Bureau. i The undersigned employer has failed to obtain workers'compensation and employers'liability insurance in the voluntary market and hereby applies for such insurance in the Massachusetts Assigned Risk Pool and expressly represents that such insurance is sought in good faith. Reques 1. GENERAL INFORMATION Effective Date: 01/10/03 1. Frank Donovan NAME OF EMPLOYER (Name the sole proprietor,general partner(s)or trustee(s)along with the trade name of the business.) j��SD(a14 ❑PENDING 2. lV/ J i FEDERAL EMPLOYERb IDENTIFICATION NUMBER (if pending,attach a copy of the IRS application.) ! 3. 153 Hickory Hill Circle Ostervllle MA 02655 - - MAILING ADDRESS Number Street City State Zip Phone 4. 153 Hickory Hill Circle Ostervllle MA 02655 - - MASSACHUSETTS LOCATION Number Street City State Zip Phone 5. None OTHER MA.LOCATIONS Number Street City State Zip Phone 6. 153 Hickory Hill Circle Osterville Ma 02655 LOCATION OF RECORDS Number Street City State Zip Phone 7. LEGAL STATUS ® Sole Proprietor ❑,Partnership ❑ Corporation ❑ Trust ❑ Limited Partnership ❑ LLC ❑ LLP ❑ Other(explain) i II. ELIGIBILITY REQUIREMENTS To be eligible to obtain assigned risk coverage: The employer's application for voluntary Massachusetts workers'compensation coverage must have been rejected by two(2)carriers; The employer must not be in default of premium for Massachusetts workers'compensation insurance; The employer must have complied with all laws,orders,rules and regulations in force and effect relating to the welfare,health and safety of employees;and, The employer must not have an audit or inspection on a prior workers'compensation policy that remains incomplete due to the employer's failure to cooperate with the insurer. 1. List the names,representatives,date(s)of discussion,and phone numbers of two insurance companies who have refused to write voluntary coverage for this risk in the past sixty days. Each representative named must be an employee of the insurance company who has authority to bind coverage. A failure to reach such a representative cannot be construed as a refusal to write coverage. INSURANCE COMPANY NAME OF REPRESENTATIVE DATE(S) PHONE NUMBER Hartford Nicholas Dalessio 118103 973-890-9175 One Beacon Barbara Brenton 118103 800-662-0156 NOTE: If coverage was recently terminated or expired in either the voluntary or assigned risk market,you must attach a copy of the cancellation or nonrenewal notice. The reason for cancellation or nonrenewal must be indicated. If the coverage was in the voluntary market within the past sixty days,the cancellation or nonrenewal will serve as one of the two required declinations. However,if voluntary coverage was cancelled or non-renewed at the employer's request,then the insured is not eligible for assigned risk coverage; coverage must be replaced in the voluntary market. 2. Have you received any offers of voluntary coverage? ❑ YES ® NO If YES,include all multi-line,deductible,or retrospective rating terms included in any offers of coverage. 3. Is there any unpaid workers'compensation premium due from you or any other commonly owned enterprise? ❑ YES ® NO If YES,provide the entity name,balance and policy number(s). If the premium is being disputed,attach an explanation for Bureau consideration. i If an arrangement for payment has been made,attach a copy of the signed agreement. 4. Does the employer have any outstanding audits or inspections on a prior workers'compensation policy? ❑ YES ® NO If YES,provide the name of the carrier and the policy number. If the employer has scheduled an audit,provide the name and telephone number of a contact at the carrier. EFFECTIVE NOVEMBER 1,2002(EDITION 01-WEB-APP) III. OFFICERS&MEMBERS For corporations,list the Name,Duties,%of Ownership and Annual Salary of each officer listed in the Corporate Articles of Organization. For LLCs,list the Name,Duties,%of Ownership and Annual Salary of each Member listed in the organizational filings. NAME DUTIES %OWNERSHIP SALARY President Treasurer Clerk NOTE: See the MA Workers'Compensation&Employers Liability Insurance Manual for corporate officer minimum/maximum payroll limitations. Certain corporate officers can elect to be excluded from coverage in MA. Sole proprietors and partners can elect to be covered in MA. Refer to www.wcribma.org for details. IV. INSURANCE RECORD YES N 1. Has the applicant previously had Massachusetts workers'compensation insurance from a licensed insurance ❑ company? 2. If YES,complete the following for the most recent three years: INSURANCE COMPANY POLICY NUMBER POLICY PERIOD PREMIUM 3. If NO,complete: New Business ❑ Uninsured ❑ Self Insurance Group ❑ Self Insured Other(explain): 4. Former Self Insurers are subject to the Premium Determination Endorsement-Former Self Insurers—1. ❑ An audit must be completed before coverage can be bound. Refer to www.wcrbma.org for details. Former members of Self Insurance Groups are not subject to this endorsement. If self insured within the last twelve months,provide the termination date: 5. Is the employer in bankruptcy? If YES,attach a copy of the approved bankruptcy filing. ❑ 6. Does this entity or any other commonly owned entity have operations in states other than MA? ❑ If YES,attach a list of employer names,states,carriers and interstate or intrastate ID numbers. 7. Has there been a name change within the last five years? ❑ 8. Has there been a merger or consolidation within the last five years? ❑ 9. Has there been a sale,transfer or conveyance of ownership interest within the last five years? ❑ 10. Did the applicant purchase or otherwise acquire the physical assets of another entity whose operations they ❑ took over within the last five years? 11. Have the owners or officers ever had ownership interest in any other entity,either currently or previously existing? ❑ COMPLETE AN ERM FORM AND ATTACH TO THIS APPLICATION IF THE ANSWER TO 7,8,9,10 OR 11 IS YES. V. BUSINESS OF EMPLOYER YES N 1. Do you supply employees to other businesses? If YES,refer to www.wcribma.org for instructions. ❑ 10 2. Do you regularly have employees supplied to you from other businesses? ❑ If YES,refer to www.wcrbma.org for instructions. " 3. MA Law provides that you,the employer,are liable for injury of employees of uninsured subcontractors. ❑ ❑ Premium will be charged in the absence of a certificate of insurance from subcontractors. Is it anticipated that subcontracted labor will be utilized during the policy term? If YES,estimate payrolls made to subcontractors without certificates of insurance. $ Transfer this amount to Section VI and identify by classification of work performed. 4. Do you use independent contractors? ❑ ❑ If YES,you must maintain documentation which supports that they are,in fact,independent contractors. If such documentation is not available,or if the designated carrier finds evidence of an employment relationship,then premium may be charged as if the individuals were employees. EFFECTIVE NOVEMBER 1,2002(EDITION 01-WEB-APP) V. BUSINESS OF EMPLOYER (continued) 5. Completely describe all operations of the employer. If there are multiple locations,provide a description for each. Completely describe any changes that have taken place in the last three years that might affect the classification of the operation. VI. MASSACHUSETTS CLASSIFICATIONS,PAYROLLS, AND PREMIUM CALCULATIONS Attach the four most recently filed Form 941's or DET Form Vs. . Describe the Duties of the Employees by Location Class Number of Total Rate Premium Code Employees Remuneration PAINTING OR PAPER HANGING-NOC-SHOP 5474 1 15,000 8.2E $1,239 CARPENTRY-NOC 5403 1 20,000 16.60 $3,320 Clerical,NOC 8810 Outside Sales 8742 Drivers,NOC 7380 Employers Liability 1001500/100 $0 TOTAL PREMIUM $4,559 Experience Rating(-0.00)or Merit Rating(-0.00) $0 ' Massachusetts Construction Credit(-0.00) $0 Loss Constant $0 STANDARD PREMIUM $4,559 Deductible Credit(-0.00) $0 VII. DEPOSIT REQUIRED: ARAP(-0.00) $0 1. Installment Options "' Insurance Charge( 10% ) $0 Estimated Installment Minimum Additional Expense Constant $244 Premium Basis Deposit Payments Under Annually 100% none TOTAL ESTIMATED ANNUAL PREMIUM $4,803 $5,000 At least Semi- 75% one DIA Assessment(4.5%)of Standard Premium $205 $5,000 Annually At least Quarterly 50% three TOTAL EST.ANNUAL PREMIUM AND DIA ASSESSMENT $5,008 $10,000 At least Monthly 25% nine DEPOSIT PREMIUM $5,008 $25,000 2. Enclosed is check number in the amount of$ 5008 Make the check payable to the Massachusetts Workers'Compensation Assigned Risk Pool(or"MWCARP"). 3. Any binding of coverage is conditional until the check has cleared. If the check is found to be non-negotiable,the check will be returned to the employer who will be given ten(10)days to provide the carrier with a bank check or money order for the full amount of the deposit premium. Only if sufficient funds are received by the carrier on a timely basis,will coverage,be effective as of the tentative binding date on the Notice of Assignment issued by the Bureau. 4. Is the premium being financed? ❑ YES ❑ NO If YES,then 100%of the Total Estimated Annual Premium and Massachusetts DIA Assessment must be sent with the application along with a signed copy of the finance agreement. • If applicable. *► Refer to the MA Workers'Compensation&Employers'Liability Insurance Manual for details. +++ Applies only to Former Self Insurers. Refer to www.wcdbma.org for details. EFFECTIVE NOVEMBER 1,2002(EDITION 01-WEB-APP) Vill. APPLICANT'S AGREEMENT — PLEASE READ CAREFULLY By signing this application,I certify that: (i) I am the employer or have been authorized by the employer to complete this application on its behalf; 46) 1 had&read and understand the following statements to which I agree by signing this application;and (iii) All information provided in this application is true. In consideration of the issuance of a Notice of Assignment and subsequent policy of insurance,I hereby certify,under the pains and .penalties of perjury,that: 1. I made a good faith effort,but failed to obtain coverage through the voluntary MA workers'compensation insurance market; 2. 1 am not knowingly in default of premium on any MA workers'compensation insurance policy; 3. 1 have complied and will continue to comply with all laws,orders,rules and regulations in force and effect relating to the welfare,health and safety of employees,including but not limited to: a. Allowing the carrier to make a careful inspection of my operation for the purpose of measuring the hazards,making recommendations for the health and safety of employees,and determining the rate or rates which are adequate and reasonable; b. Complying with the carriers'reasonable recommendations aimed at controlling or reducing the hazard(s)insured against; c. Keeping records of information needed to compute premium and providing the carrier with copies of those records when asked for them;and d. Fully cooperating with the carriers'attempts to conduct premium audits or inspections of the premises for loss control purposes. I understand that the employer's compliance with each of th certifi .ons is material to the issuance of Assigned Risk Pool coverage. Business Name of Employer Date ignature an kle(Sole Proprietor,General Partner,Corporate Officer,Trustee or Member) NOTICE: This insurance is being provided through the MASSACHUSETTS WORKERS'COMPENSATION ASSIGNED RISK POOL,and not through the voluntary market. The employer's non-compliance with certifications 1,2 and 3(a—d)may,to the extent allowed by Massachusetts law,cause the carrier to initiate a mid-term cancellation. FRAUD NOTICE: Massachusetts General Law,Chapter 162,Section 14(3)provides: "(A)ny person who knowingly makes any false or misleading statement, representation or submission or knowingly assists, abets, solicits or conspires in the making of any false or misleading statement,representation or submission, or knowingly conceals or fails to disclose knowledge of the occurrence of any event affecting the payment,coverage or other benefit for the purpose of obtaining or denying any payment,coverage or other benefit under this chapter; and any person or employer who knowingly misclassifies employees or engages in deceptive employee leasing practices for the purpose of avoiding full payment of insurance premiums...shall be punished by imprisonment in the state prison for not more than five years or by imprisonment in jail for not less than six months nor more than two and one-half years or by a fine of not less than one thousand nor more than ten thousand dollars,or by both such fine and imprisonment." IX. AGENCY INFORMATION AND PRODUCER'S STATEMENT The producer hereby certifies,under the pains and penalties of perjury,that all information provided is true to the best of his/her knowledge and belief and that he/she made a good faith effort to place the coverage in the voluntary market as required by M.G.L.,c:162,Section 66A. AGENCY Leonard Insurance Agency,Inc. 04-3496504 Name(Printed) Agency Federal Identification Number ADDRESS 7 Wlanno Avenue P.O. Ostervllle MA 02655 508428-6921 Street City State Zip Code Telephone PRODUCER Deborah James 1555379 Name(Printed) Signature Date Agency License Number MASSACHUSETTS WORKERS'COMPENSATION ASSIGNED RISK POOL ADDITIONAL INSTRUCTIONS PLEASE READ CAREFULLY 1. Applications will not be accepted by FAX machine. 2. An additional or replacement entity cannot be endorsed onto an existing assigned risk policy as a named insured unless an application and check are submitted and coverage is assigned by the Bureau. Refer to www.wcribma.org for instructions. 3. The Pool is able to provide coverage only for MA employees. If an employer has operations in any state other-than MA,or commences operations in such state after policy inception,application for coverage for those operations must be made to the appropriate Bureau or other agency administering the Residual Market in that state,if voluntary coverage is not available. 4. When a Pool policy has been cancelled twice by the insurer for nonpayment of premium,the employer will lose his payment plan,and payment in full of the remaining policy premium will be required as a condition of reinstatement. 5. When a Pool policy has been cancelled twice at the request of the employer,the producer of record or the finance company,the employer must reapply to the Pool for subsequent coverage after all outstanding balances have been paid. 6. Applications for joint ventures must include a copy of the joint venture agreement. 7. Payrolls and classifications are subject to review by Bureau Staff and may be changed. 8. The Waiver of Our Rights to Recover from Others Endorsement,WC000313,is available to employers who require the endorsement by contract. Refer to www.wcribma.org for details. 9. Agents are not agents of the MA Workers'Compensation Assigned Risk Pool and cannot issue Certificates of Insurance. 10. If you have any questions about the rules governing the MA Workers'Compensation Assigned Risk Pool,refer to the Bureau's webslte,www.wcfbma.org. If additional information is required,contact the Workers'Compensation Rating 8 Inspection Bureau of MA at (617)439-9030 or write to either P.O.Box 55005,Boston,MA 02205 or 101 Arch Street,Boston,MA 02110. EFFECTIVE NOVEMBER 1,2002(EDITION 01-WEB-APP) Barnstable Assessing Search Results Page 1 of 2 QM Ass", � x z0- �« 440 } Home: Departments:Assessors Division Property Assessment Search Results —back to search 4 WIANNO AVENUE Owner: HANSEN,WARREN E& BARBARA A TRU)perty Sketch Legend Map/Parcel/Parcel Extension irpj7E a $ 117 /090/ Mailing Address HANSEN,WARREN E&BARBARA A TRS WARREN &•BARBARA HANSEN TRUSTS 147 SCUDDER RD OSTERVILLE, MA. 02655 ,.m Assessed Values: Appraised Value Assessed Value "x Building Value: $81,700 $81,700 Extra Features: $0 $0 Outbuildings: $0 $0 Land Value: $327,300 $327,300, Interactive Property Map: Map requires Plug in: Totals:$409,000 -$409,000 'ave visited them bef ep&UM R a�f i, of Iy andPE&lf Se Sales History: Owner:, Sale Date Book/Page: Sale P ' HANSEN,WARREN&BARBARA 4/15/1992 7990/173 $ 1 OF114E Tp�f,� HANSEN,WARREN&BARBARA 1391/340 $ HANSEN,WARREN E& BARBARA A TRS 5/22/2000 13024/044 $ * BARNSTABLE, '`► 9 MASS. g Tax Information: Tax Rates: (per$1,000 of valuat i639• �� .. ArED MA't�` Town Tax $3,844.60 Town. Fire District Rates ther Rates 9.40 Barnstable 2.88 Land Bank 3%of Town Tax C.O.M.M. FD Tax $629.86 C.O.M.M. 1.54 Cotuit BUMD� DIVI G SION I : $$ t Land Bank Tax $ 115.34 HyY•' 2.89 West Barnstable 1.96 http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessingi.... 1/29/2003 i Barnstable Assessing Search Results Page 2 of 2 i Total: $4,589.80 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.13 Year Built 1953 Appraised Value $327,300 Living Area 4302 Assessed Value $327,300 Replacement Cost$302,629 Depreciation 25 Building Value 81,700 Construction Details Style Store Interior Floors CarpetVinyl/Asphalt Model Ind/Comm Interior Walls Drywall Grade Average Grade Heat Fuel Gas Stories 1 Story Heat Type Hot Air Exterior Walls Stucco on Wood AC Type Central Roof Structure Flat Bedrooms Zero Bedrooms Roof Cover Rolled Compos Bathrooms Zero Bathrms Total Rooms 1 Room Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area(Unfinished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Un 4,hekilit At'c}�FEP Enclosed Porch PTO Patio Departs&t a P(Onfinished) �FHS Half Story (Finished) SFB Semi Finished Living Area and EnwRb Semces FOP Open or Screened in Porch TQS Three Quarters Story(Finished) °F SME ram, * BARNSTABL,E, y MASS. i639' 1� �rED MOB A BUILDING DIVISION BY: http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 1/29/2003 i 705 117090 " .` wad k4.✓' t Mk AM-�,%� yE y \\ 42 Department of Health, Safety and Environmental Services * BARNSTABLE, 9 MASS. i6gq. 1� �rfD MA'S a i BUILDING DIVISION BY: . �N :: r f ..z 4 r^�: �. x k:�-x u g s t�,a�'4 :� �. ��vW ti• .s �' � � r 5 s 17080 3tf NET,17 ::: � � s r� sx x. �,�.,-x�E F-���,�. ,Y.r•:yE .�"`�s•d� �f>?� v � -:,_.._..s E -r�`�r .;z:., r ,�...a � .1 yc..-. a,.�- 7�.( E "t-c :� �,'rr ,. z s� vx' ..:. 4 k :w+"sfz 3*-<,,.�v., :.. z > f �'''�" i '•4,r v 't xf � ",n Rills NE .E ! L i "�a "�`<• �"T ''"'"�'". .�-C�sW�;:".r w-s .. �. �'� ,a� a� �4 siN �. a h. r 4, htx ,� y 'u,r rvz'�45a; a fs"yy •.. ik 708 � � ss wry 825 , 4 5 r � ��;w�' S r-r i �� 4,s� E� � �� �` '" *.. � w 117099E11�7091 ; 4 :E�j gar �` J''n.::-4.`+E a "Ex. xt�"r '�`=i-F"fx yy ?4w?'6• : y is Y # 1 p ii �J we }` ;4,�'� Y+- :� x�::�:�.'�� �•'�.-x, '� "t E'er...W..���� .;x���Er$'�;� �: / �: �x•,dF;�, € t. �,� 5 E- x.�E.'n. -"�"� 5� �s€ ,,,,,'v�s�.�'.s'�r �,. }€, -i. E 'n '- r. s. � a`� �r�� �`✓'�1'�`tv'�"r� :*�.:�`� i .E'x .�s Q..-� '� s a-r �� r rr':.4u-�,.f.G a+ 's": ;si. " :<e�.:E: = �;. _.J` Su:� -� x� �~�� ..s� r �' Ste: s °�DES• +�n..„ss��asRA MR Mi ,`�-� "'!4as 1711 xs 117098 ffi y:yy;. - 2 ` a.. Department of Health,Safety and Environmental Services IME ti°� BABNSTABLE, 9 MASS. BUILDING DIVISION BY: t r i ' *r 3 i T f Department of Health; Safety and Environmental Services �F SHE rpm * BARNSTABLE, +► 9 MASS..• �► 039. 1� BUILDING DIVISION TOWN OF BARNSTABLE i SIGN PERMIT PARCEL ID-'117 090 GEOBASE ID 5838 'ADDRESS 4 WIANNO AVENUE PHONE OSTERVILLE ZIP: LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 48156 DESCRIPTION "KINLIN GROVER" - 2 @ 10 S@. PERMIT TYPE BSIGN TITLE- SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $50.00 BOND Ti1E .00 CONSTRUCTION COSTS $.00 753 -MISC. NOT CODED -ELSEWHERE 1 PRIVATE PF VE� . * BARNSTABLE, • MASS. 039. �� I BTU[ ! LI DING DIVISION ,p DATE ,ISSUED 08/21/2000 EXPIRATION DATE ----- _j - ofIMMErOwti The Town of Barnstable Department of Health, Safety and Environmental Services RARNSS �I,E, : Building Division v . 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 � Building Commissioner Fax: 508-790-6230 Tax Collector Treasurer ® ` Application for Sign Permit Applicant: E& 3 '1 "Z'. Assessors No. ✓ �tVO"%Grog GtM►�C- Telephone No. `-0%- 43P- 1�3D Doing Business As: / Sign Location Street/Road: � Zoning District: Old.Kings Highway? Yes/& Hyannis Historic District? Yes/ Property Owner �p — //�a Name: Telephone: / p Village: Oat G S.S Address: .. Sign Contractor . Name: UNx" 5� Telephone: `^ Address: �� Tozer a Nth Village: �`� Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions, location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be'electrified? Yes/6 (Note:If yes, a wiring permit is required) I hereby certify that I am the owner or that I have the.authority of the owner to make this application, that the information is correct.and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: Date: Permit Fee: L52G- Sign Permit was approved: Disapproved: Signature of Building Office Date: Y Sign l.doc rev.&31/98 t GMAC �ROV o„ INLIN G 1E R 138' LETTERING DETAIL OVERALL 51ZE 10"X 138" 1050. FT. 542.00" GMAC 4 WIANNO AVE., 05TERVILLE, MA TWO 2' HIGH X 28'-6"WIDE SHED ROOF AWNINGS N BLUE 5UNBRELLA FABRIC WITH WHITE LETTERING LETTERING AREA 15 10"x 138"= 10 5q. Ft. PER AWNING 20"00 ONE 2' HIGH X 10'-10"WIDE SHED ROOF AWNING 51DE VIEW BLUE 5UNBRELLA FABRIC WITH NO LETTERING CLIENT, DATE f THIS DRAWING CONTAINS PROPRIETARY INFORMATION AND DESIGN CONCEPTS AND IS PROPERTY OF U�u 10 GJ20U�dt(,vtitOK UNITED SIGN CO.,INC. IT IS BEING PRESENTED TO YOU FOR YOUR EXCLUSIVE USE AND MAY cau NOT BE - 33 Tozer Rd. PO Box 3106 LOCATION DESIGNED BY COPIED OR SHOWN TO ANYONE OUTSIDE YOUR ORGANIZATION WITHOUT OUR WRITTEN PERMISSION. E CHANGING OF COLORS,SIZE,MATERIALS,OR ILLUMINATION DOES NOT ALTER THE BASIC DRAWING. Beverly,MA 01915 Phone 978-927-9346 Fax 978-927-9351 r J 1 a 1 fir, a�-77wwr. NO 1. Wo E*vs-Il o(q5 W1 Lzl-C l%Q(q -tb 4:- R-E Vl-� 0 y wovo hue osTt::IzUkLL' Y _ �Y n. ONE E*s'tiko(, w�M6wT LEn-e(40L TO 33 Tozer Rd., P.O. Box 3106, Beverly, MA 01915 (978) 927-9346 Fax(978) 927-9351 To: Gloria M. Urenas From: Ed Juralewicz Fam 508-790-6230 Pages: 14 �z Phone: 508-ra5:4036 Date: August 14,2000 ♦ Urgent ♦ For Review ♦ Please Comment ♦ Please Reply ♦Please Recycle Enclosed is an application for a sign permit to replace the existing awnings for Kmlin Grover Real Estate in Osterville. There are 2 awnings with lettering and one awning without lettering. A check for the fee is also enclosed. Any questions�.regarding this application should be directed to me at 978-927-9346. Thanks for your help, ` Ed Juralewicz i E I I i N AR �fiEt 0 AM =\fisveG ,801-C issoT U t dEQ iS i P} xs=1 L�� •� ' 1 WEE r . sz;,mV ut•b3 ttr,oil s�QkD :61• OWN,,h-C 12ugLA ;OtrA 'enotilq 1saF! .uvo".O oiktDi .e, aqu:r-4vr, Qnituxe srB wsigs7`e; It Tieq n�l:� 3 ,101 r)olis:;;Igg4 n al bazobnH iui �3rb A .gnha" iuo a! r$iw�nirv. eqo b,r s gnip ctte! rtive zenhws E gi � !l_ ,eDr*lllp0 nl WIAO .b,obne ei orif cyFf -�5?-SrF Jr.em dl tabs- 7;u Ad t*joria noltso!kgga eirb pnibisgsi,noite-o r,vnh Ql�si yuQ'(�ofi �n, niwolsiut.b:? I I I The Town of Barnstable BARVSASS.TABLE. ' Department of Health Safety and Environmental Services M 0 ��Eo►Ap•� Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: AeA0A1&74 &4,f?6-a/ //, )Y670y Map/Parcel: Project Address: V wi a mo Builder: //f-9 r- 141 ce L u FF The following items were noted on reviewing: �� �/77.���'1�NGy �/�f�TS � �X/?' .J/6T/S '" ETA, " IQ��-(J t ✓��7 �/y Reviewed by: Date: The Contntonit'ealtlf of AtassuchIAettt Xi _._71;_..- Department of Industrial Accidents Y ' • 1 t 1 office ollnveslJgat/ons 600 li uAinhton Street Boston.,Huss (12111 Workers' Compensation Insurance Affidavit ----at-io..n• -•-- Please PR1NT lesi �.."'_'..-.._."'�._..".,,..._-,�_,., aliilOER inform tnmr' lncition- CiIN. Chem•# � 1 am a homeowner erforminz all work myself. I am a sole proprietor and have no one working in any capacity .-....:...�..'_..��;.�-•..--.....�_w�!:sir.s..-.w��l�can.'wee+�'1,7�Ta.�".-ITo•w.C+.+!.•�I��....�w.�.�....Y..�...•.n., .w•.�r►.w....-•...--_...:. - m an emplover providing_ workers' compensation for my employees working on this job. opt rtnv narnc: i d d ress insurnnce co /l/�id��I (�/ ��! t� noiicA.# [) I am a sole proprietor. general contractor• or homeowner(circle one) and have hired the contractors listed below who have the followin_ workers' compensation polices: comnativ n•ttne• address- city: phone#- - insur-ince cn polies # cmmynnv nirnc• address- city- phone#: insurance co nolicv# .Attach additional sheet if neccisa ": :== == �'^'�'�"�_•. '` "''-�'`�== Failure to secure coverage as required under Section 25A of 111GL 152 can lead to the imposition of criminal penalties of a line up to S1.500.00 andiur one scars' imprisonment as well:is civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a cope of this statement may be furwnrded to the Office of Investigations of the D1A for coverai!c verification. 1 tlo hereht•certift•under the pains mid pelt tes of perjurt•that the information provided above is true and correct. Sianature Date/f Print name •� Phone# G � ' official use unly do not write in this area to be completed by city or town official cit, or town: permit/license# t-113uilding Department Licensing Board O check if immediate response is required (]Selectmen's Office ►_ '.' (Health Department contact person: ' p hone#: nUther. i. Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for t employees. As quoted from the an enipl( ree is defined as every person in the service of another under an, contract of hire, express or implied. oral or written. An enrplt rer is defined as an individual. partnership, association. corporation or other legal entity•, or an\• two or m the foresoing enLa�_ed 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 owner of a dwelling_ house having not more than three apartments and who resides therein, or the occupant of the dwciling house of another who employs persons to do maintenance , construction or repair work on such dwelling ! or on the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo: MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for an• 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 peribrmance of public-work until acceptable evidence of compliance with the insurance requirements of this chapte- been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation an. supplying_ company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the'Departtnent of Industrial Accidents. Should you have any questions regarding the "law'or if you are requir to obtain a workers' compensation policy. please call the Department at the number listed below. City or,roivns Please 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. P be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returner the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for;you cooperation and should you have any quest; please do not hesitate to give us a cz-ll. 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 fax #: (617) 727-7749 ni,nnn 4+•. (41 7) 777-190n nvt. .106. 409 or 375 any �S i 1. f.•. r• n (Iln Yr I r III I ; -I ri oE�f�o1llrlrlrOpprlI Joi,�. .i;�r.l ,� �f.u4l �•�I�{fnt�pl`��I �11gEIV�l�ro,l 1L4t.1: „}ai!. 1h neSOiliY w1i1' /" !look A !S. i dal! ��:i�•f'` D!! I• �^� Frllrrrytar�s3trauAymir:a;P 7S � ��. ii•c Mass achir.atre;'e-i` '..'•:r .1:,!6•i!ty_'i :l/t P.Z009I411/Mt(IKYI/��O�✓�f.1I;UIIC'�If.1P��J _ HOME IMPROVEMENT CONTRACTOR Registration 110485 _ Type - INDIVIDUAL — — Expiration. 10/20/98 GROVER u MCELHENY BUILDERS STEVEN P. McELHENY 1&BOX 1058/523 MAIN ST / ADM,NlsTRATOR OTUIT MA 02635 Engineering Dept. (3rd floor) Map Parcel O Permit# House# Date Issued c�7_ 02 Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30)k3-a )�ee 7 S SEPTI#' CODE U57'SE Definkivo Pisa 19 INSTALLIANCE TOWN OF BARNSTABL�NVIRO AND Building Permit Application TOWN REGULATIONS Projec Street Address Village Owner Address Telephone G — Permit Request ScF 776Y,--7) ILI, i � First Floor �.'S�� squa a epet econd2 Floor square feet Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)--_ Age of Existing Structure Historic House ❑Yes 8'N'o On Old King's Highway ❑Yes wdo Basement Type: ❑Full ❑Crawl ®-Wailkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ,S'ZV Number of Baths: Full: Existing 4— New Half: Existing v7 New .,No.of Bedrooms: Existing _New Total Room Count(not including baths): Existing New _(_49 First Floor Room Count Heat Type and Fuel: as ❑Oil ❑Electric ❑Other Central Air es ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yeses . Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) one ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial es LINO If yes, site plan review# �1 _ Current Use Proposed Use S Build r Information Name A Telephone Number Address ©i e License# G G/ o 93 Home Improvement Contractor# Worker's Compensation# 111KI2-m NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO c SIGNATURE DATE BUILDING PERMIT D IED FOR THE FOLLOWING REASON(S) '. FOR OFFICIAL USE ONLY PERMIT NO. x .r DATE ISSUED' , ;E MAP/PARCEL NO. ' 1 ADDRESS VILLAGE° i OWNER DATE OF INSPECTION: + FOUNDATION FRAME INSULATION I FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL' : , , GAS: k0,1WH Q FINAL ' - - FINAL BUILDING DATE CLOSED OUT , 'i X ASSOCIATION PLAN NO!;. fib tin � { • � '_ GMAC Mortgage Corpora'tion W�g UKUD SYSTEMS [MG1MRS USI Construction Services, Inc. 4 Walnut Grove Drive Hom e S ervices Horsham, PA 19044 4 Wianno Avenue -10 -12212�VISED PLANS Osterville MA 02655 0 4a C3 0 # DRAWING INDEX It 0 in-V CS COVER SHEET iw D-1 DEMOLITION PLAN f %mi A'A it --I A-1 ARCHITECTURAL PLAN AP ;t Irsto i 7y�m A-2 MILLWORK DETAILS U , DI "JF ;Q k,C , . " S, .-T J.. 5 nuiz-,- 00 'rill]4 7 Lk-- A.- E-1 ELEC. VOICE DATA PLAN uu)) -�N, Barnsta eAt - �,�r,e. , fi " E-2 LIGHTING PLAN CM U) (0 0 0 Ile w Ljj F-1 FURNITURE PLAN C) E Z-3 < �Aw k" W, � Az A 428 f -- " * "' " " '% QY 2 A :A-,Znl�'k C/) .0 4 Wianno Ave SYMBOL LEGEND Ir If Uj Osterville, MA 026 5 yj C: >Cz S. ON age-- vtm!��)'L:Yj, T:4 0 3: DETAIL N&IBM 0 SWM NkSER V At W)L Z;� $�P-7. r SCkE: Iq It ELEVATION MAW NT5 —4P A er r DATE: 3) M DETAIL N&SM 'g-— j4R, , - ; 01/02/2002 SHEU WIER w DRAWN BY: ifs, r b DrVs' u. i, III Eti, RjG CHECKED BY: &a It -4 w SECTION MARK f i-. 5t Fx 0. tx. J 4 SEET MkIWR PROJECT No.: E3jB D171: 44. y DVAL N&SM 4 w 1P @ g*, �.n 2�, f$�;itll !� - 4—t '. - SECTION MAW 1201-348-000 .4 1'�r n DRAWING: C z f t? A RXM NAI-E "Zi FWM N21BER .7, E�J -ocation Map ROOM IDENTIFIER CS DD J e �r o m Q^� nE x o. Cd IL . a DR 74 Or � � YalTO O f w g I _ C- M 1 N u7 O m 3nm X- 1 N T T �_ -) rn !� 9 � 0 q � W4 L GMACMDMA6E WRFbRATION ®60►� R��i �c NOW SERVM 4 MMW AVM y O o f L' J 05TOMLLA MA 026 _y ES h �► DRAINS TM.B rb {1 ARLF MTIAQALPIJW , \e I n \ �A� Ilo \.e o m I r` C ;=f E o ( -U ;' dirt Ell, �- E i� JII"IIItI' �t i I i �_��e� E I'�a1j O -ram j i I N, 6, WVAG m 13 E3 X .• s.=\, s, (p N .•. E 3N Z < D �!!f :t b m D nT -m T- - p�1o � Z r_ x EE`erX. as - 7 3 vyj no NEV uoset !`.�..__.�ti� -'` �,.:�,�I �� / ` •.j I D .4 - �" I .1 4 3.• , tv O ��p / I v 1,• —4 II B N ! 7C 1 II N �..r ....?.A!_ ..4 .......� I uu N w� N T I F EA -L- N g � CP X �� P � ?. Dm � �D rpr � O ; OD I>. NN �j «. m n p (P NG� Ux—,—, m mmIm o � m N o (p m u► � cl N Q E E N E I- E m -n {O{ D E 0 TO pE O rpm r= ,Q X E E �N z Zl w 1 t Z r 1 N Z Z \✓ f7T N ODO � rl>- D Q��i � Sn ae ov SHE r�ix oQ x z �D � E O � COl -ZU t�0 3 'Du0' 0 �+' D3r5 < mm r- O r Oz O -4Dp D m Uloo UJ 3 Ljr cn �N �1 � p0 1p N CT� u' � 3 Ul3 Ul3 � � r19 co U1 .. o o � -< -< -< r ENrr- D D Dti= U3 to U3 -� m m 0 Z x C7 N A = CD g PROJECT:PZ _ m f Q t 0 o z o m GIMC Mortgage Corporation o D w HOME SERVICES o 00 0 4 Wianno Avenue c W a p o �' OstervlIle, MA 02655 iu _ DRAWING TITLE: SFIT i`� y� U3 0 e ARCHITECTURAL PLAN MILLWORK NOTES: o Sysm mupATOHS L ADJUSTABLE SHELVES I/4�OIA.-HOLES a I' O.C. UNrrE_ USI Co Walnut Grove Dries Inc. FOR NICKL-f PLATED SHELF SUPPORTS ve Horsham, PA 190" 2. ELECTRICAL OUTLETS MTD.HORIZONTALLY B 44' AFF. 3. PLASTIC LAM.COUNTER.AND BACKSPLASH COLOR, STYLE 4 MANUF TBD. 4. PLASTIC LAM.CABINET DOORS AND DRAWERS W/ o.7396 ADA COMPLIANT PULLS. • o .OTUIT f o 4ASS. J� 5. CONTRACTOR TO PROVIDE SINGLE BASIN SINK, r �► FAUCET AND CONTROLS IN COMPLIANCE WITH ADA, ANSI Ill.l'AND THE UNIVERSAL ACCESSSIBILITY ��. CODE. CABINETS TO WRAP AROUND EXIST.COLUMN - VERIFY ALL DIMENSIONS a PRIOR TO FABRICATION 0 j 2b 2a •� _ A-2 A-2 4 A-2 FI I' SCRIBE EQ EQ I'-0' I'-0' `-2'-b' `-3'-6' CABINET FACE CABINET FACE V.IF. � J i / \ r-——————————— iv REFRIGERATOR FURNISHED BY TENANT +a to J to Q � w a) CV = O F- U C — 0 i i 214 2'-1' j Q U W ¢ �— n l \ U) \\ t ' III \\ // W � i -------- -� I I �\ SCRIBE \ 0 I I \ III -- \\ 2 Ct O v Q I I c" \\ III ; , \` // � SCALE: SCRIBE `\ FILLER AS NOTED DATE: ------------I N 01/01/2002 31 ow,wN BY: R.1Cs 2'-6' ±2'-2' 1'-8' , 2 -0 2'-0 t1'-9 ' t3'- 2'-0l CHECKED BY: BJB v.IF. 2a-CABINET 2b-SINK CABINET WIDTH v.IF. CABINET WIDTH V.IF. ±(0'-1 ' V.IF. SECTION SECTION PROJECT No.:1201-348-000 DRAWING: ELEVATION BREAK ROOM COUNTER 2 SECTIONS COUNTER 3 ELEVATION PANTRY a SECT. PANTRY A-2 Scale: 1/2' = 1'-0' A-2 Scale: 1/2" A-2 Scale: 1/2' = 1'-0' A-2 Scale: 1/2" = 1'-0' A ISSUE: DD � 0 o m . I.' O � r • zN 8 DmclG� m Z EE �Op o ❑ 1 xo� f fMJ m ° , PA A prD- ❑ EE �, m r� X zD Z z ❑ tR - E m D - HVAC �1 3 0 EQUIP. O N ❑ 0 ti) N r ❑ in x z < g � N oho z 20 M _ m o - -- -- -- I3 E _ � NOD ❑ N X i --f zju (P D ' m ° pp mNX c 1'-3' 6'-0' ' W l9 D r 3'-0' I'- z ❑ w � 3 N n O mX§ G EPEE r � 6z o � m ZE X f. 74 \7p v rr m Em Em Em i E E g E 9n —n � O = OL rcrp m m r Z Z m gym - o � o D � m 3 m -4 D m 0 ,1 � Ns r- I1 j! N1 m ° n F �> m O n D Z N O fT� II rm � ° �r1 -� Z II II �I r r Z - O oX x m e. N n - o 2 z PnE m tl ° m tp ,. c N o n PRDJECT: R GNMC Mortgage Corporation T o 1 HOME SERVICEScz ` F 4 Wianno Avenue Osterville, MA 02655 9 = 3 .0 '� DRAWING TITLE: ! �J' F U, , Ia DEMOLITION PLAN } ELECTRIC NOTES: «Q PROVIDE FOR lU 20A CKT. I. PROVIDE (1)20 AMP CIRCUIT FOR EVERY lb) - ELEC/YOICE/DATA FOR WORKSTATIONS FOR COMPUTER LOAD. y 5 WORKSTATIONS ti PROVIDE F1.00R MTD. 1. PROVIDE li)20 AMP CIRCUIT FOR NO MORE TWAIJ(b) UcmBn Srsm[rmmlogs w ?0A. — d 0 OS!coutmetioa services:Inc-." 0 WORKSTATIONS OR NON-COMPUTER LOAD. /y 0 4►chat Grope 16"LEC OIGE/D' 3. PROVIDE ll)10 AMP DEDICATED CIRCUIT PER(6I Harah m PA ItM e WORKSTATI ' DF 1 CkWORKSTATIONS FOR PRINTER(VERIFY w/TENANT). Q� �,,C 4. PROVIDE A SEPARATE NEUTRAL FOR EACH,CIRCUIT. NO SNARED TRAILS. r PROVIDE FOR(1)20A 5. PROVIDE(1)DUPLEX RECEPTACLE FOR EVERY 124-0' P ' CKT. - ELECJVOICEJDATA f� OF WALL,(b)ETS PER CIRCUIT. FOR 2 WORKSTATIONS 7 96 b. PROVIDE (1)DUPLEX RECEPTACLE (ADJACENT TO C TUIT 4. PROVIDE FLOOR MTD.JB w/ t DOOR)IN ALL STORAGE ROOMS. M S. y 20A CKT - EN/0 (I)CKT. •�, 1. PROVIDE (1)DUPLEX OUTLET EACH INMECHANICAL, ---- -- _ FOR EA WORKSTATION ' ELECTRICAL,AND EQUIPMENT CLOSETS.` 0 0 9 P 0 S. PROVIDE f 1)20 AMP DEDICATED 120 VOLT(FOR COPIER) k(1)20 AMP DEDICATED 120 VOLT RECEPTACLE FOR PRINTERS AND PHONE/DATA FI _. _ FAX cat R -_( t 3 EXIST:EN/D/ IN EXIST EQUIPMENT AS SPEC'D ON EN/D PLAN. O VIDE FOR(1)20A. - — 0 -- . `� OFFICES TO REMAIN 'AS-W. 9- PROVIDE (2)20 AMP 120 VOLT RECEPTACLES IN +� CKT. - 07W7 RE-CUIRSUIT IF REQ'D. VENDING iEAS. Z ELECJVOICE/DATA t ' 10. FOR DATAjROOM PROVIDE CIRCUITS W/SEPARATE Q FOR 1 WORKSTATIONS 9� PROVIDE FOR(U 20A NEUTRAL,GROUND AND BREAKER PER RECEPTACLE. 01 J CKT. - ELEC./VOICE/DATA II. SEE HA 10" 'PREMISE' SPECIFICATIONS FOR O Q --- FOR 5 WORKSTATIONS SYSTEMS IN-FEED REQUIREMENTS. __ _ 12. ALL OUTLET COVERS TO BE WHITE. Q ° '- 13. ALL OUTLETS TO BE LOCATED AT INDUSTRY 0 n STANDARD 48' ABOVE FINISHED FLOOR UNLESS � W PROVIDE FOR(1)20A NOTED OTHERWISE. V CKT- - ELEC/VOICE/DATA 14• FOR TELE/DATA CABLE PROVIDE A 1' DIA.CUTOUT 60 _ _ _ _ FOR 2 WORKSTATIONS FOR NO MORE THAN 4 WORKSTATIONS. N X� t O iQ W (1) cm PROVIDE FOR(1)20A CKT. C.) c Q - -- __ __ _ I + �' - ELEC/VOICE/DAtA FOR 3 SYMBOL DESCRIPTION > < COMP.WORKSTATIONS V W Q DUPLEX ELECTRICAL OUTLET - 120V CIRCUIT. w 0 E DENOTES EXISTNG,(TYPJ W V _-- NOTE: $ DUPLEX ELEC.OUTLET - 12OV CIRC. _W_I ---- EXISTING ELEC.DEVICES GH GFI -- GROUND FAULT NTERUPTOR PROTECTED. COJ- W � X: 0 -eW � f TO REMAIN EXCEPT a THOSE REMOVED DURING SEPARATE CIRC,SPECIAL PURPOSE 5-20R a o DEMOLITIM RE-USE OUTLET.DEDICATED FOR COPIER SEE CRITERIA PACKAGE,DIVISION 16,ELECTRICAL,POWER SSE EXISt.CIRCUITS.AND - I/8' = 1'-0' DEVICES AS REQ'D. TO + QUADRUPLEX ELECTRICAL OUTLET - 120V CIRCUIT. DATE: MEET DESIGN NEEDS. 01/01/2001 CUTOUT RING AND PULL STRING FOR TELE.CABLE. DRAWN : \ - RJG CUTOUT RING AND PULL STRING FOR TELE.AND DATA CABLE. CHECKED er: pp� W B CUTOUT RNG AND FULL STRING FOR DATA CABLE. PROJECT No.: B BINDLE VOICE/DATA CABLES 1201-348-000 ELEC.GANG BOX FOR WALL WHIP TO SYSTEMS DRAWING: 1 E/V/D PLAN - ����, -� -: FURN. INFEED. E-1 Scale: 1/8" = 1'-0' - �� E-1 ' ISSUE: DD m i. Z I r _ Z i ❑ ❑ . I I HYAC // I EQl1IP. I I 1 o ¢ ! i Rom �\ v '`\ LO ❑ � I Nd 7� m 1141 -1 i t I o r' CDo n PROJECT: ®�lsA --- o = GXMC Mortgage Corporation o rn w HOME SERVICES No-4 - "-- o o 4 Wianno Avenue IVcp _ e Osterville, MA 02655 ° R C DRAWING TITLE: U a LIGHTING PLAN �, ^''' _--- .: ., �' I 1 r �� U, .��a° r: i •T �'< }x w 00 I el Ent `+7C { ✓d! rr v a 'r T y6 �� f e. - - - - . _ 4 _ 1 t - Peter Hansen Design �S' G oV �---- M� VINTAGE LANDSCAPES J S; Peter Hansen Design ------ • II Peter Hansen Design VtNTACE LANDSCAPES y h. Peter Hansen Des' - - - " - F _